Provider Demographics
NPI:1134983596
Name:PARKS, TACHELLE M (ADC)
Entity type:Individual
Prefix:MRS
First Name:TACHELLE
Middle Name:M
Last Name:PARKS
Suffix:
Gender:F
Credentials:ADC
Other - Prefix:MISS
Other - First Name:TACHELLE
Other - Middle Name:
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADC
Mailing Address - Street 1:3639 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-7701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1245 GARDENIA DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:PA
Practice Address - Zip Code:17366-8527
Practice Address - Country:US
Practice Address - Phone:717-578-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3441101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)