Provider Demographics
NPI:1851769947
Name:PARKS, BERNESHA (EDS, LPC)
Entity Type:Individual
Prefix:
First Name:BERNESHA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 HERITAGE VLG STE 16-139
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6140
Mailing Address - Country:US
Mailing Address - Phone:470-709-2792
Mailing Address - Fax:
Practice Address - Street 1:6645 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1606
Practice Address - Country:US
Practice Address - Phone:770-455-7111
Practice Address - Fax:770-274-3460
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009042101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health