Provider Demographics
NPI:1134584576
Name:PARKS, MEGAN D (LSW, LADC, CCS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:D
Last Name:PARKS
Suffix:
Gender:F
Credentials:LSW, LADC, CCS
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:D
Other - Last Name:GRIFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2515
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-2515
Mailing Address - Country:US
Mailing Address - Phone:207-344-7577
Mailing Address - Fax:
Practice Address - Street 1:83 CHESTNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7766
Practice Address - Country:US
Practice Address - Phone:207-344-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5863101YA0400X
MELC7002101YP2500X, 101YA0400X
MELS19860104100000X
ME171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator