Healthcare Provider Details

I. General information

NPI: 1407972961
Provider Name (Legal Business Name): SARA PENNINGTON PARKER M. A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 MAIN ST STE C
DAPHNE AL
36526-8624
US

IV. Provider business mailing address

1290 MAIN ST STE C
DAPHNE AL
36526-8624
US

V. Phone/Fax

Practice location:
  • Phone: 251-313-3051
  • Fax:
Mailing address:
  • Phone: 251-313-3051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1844
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1844
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: