Healthcare Provider Details

I. General information

NPI: 1306330865
Provider Name (Legal Business Name): LAUREL ASHLEY PARKS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 11/04/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 N CENTER DR STE 200
NORFOLK VA
23502-4008
US

IV. Provider business mailing address

1100 BATTLEFIELD BLVD S #15979
CHESAPEAKE VA
23322-9998
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-0003
  • Fax: 757-233-1669
Mailing address:
  • Phone: 954-999-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: