Healthcare Provider Details

I. General information

NPI: 1821938671
Provider Name (Legal Business Name): ALICE MARIE PARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 APOLLO DR # B29
UPPER MARLBORO MD
20774-4924
US

IV. Provider business mailing address

2208 JEROME DR
FORT WASHINGTON MD
20744-3253
US

V. Phone/Fax

Practice location:
  • Phone: 240-795-2883
  • Fax:
Mailing address:
  • Phone: 240-795-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17631
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: