Provider Demographics
NPI:1962667980
Name:PARKS, MOLLY WOOD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:WOOD
Last Name:PARKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5842 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6293
Mailing Address - Country:US
Mailing Address - Phone:919-572-0000
Mailing Address - Fax:
Practice Address - Street 1:4415 TALCOTT DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6130
Practice Address - Country:US
Practice Address - Phone:919-937-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC4095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program