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General NPI Number Information
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NPI Number | 1063649895
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Entity Type | Individual
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Provider Name | SUSAN MACKAY PARKER LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 14 MAIN STREET OFFICE #9
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City | BETHEL
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State | ME
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Zip | 04217
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Country | US
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Telephone | 207-595-9978
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1187
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City | BETHEL
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State | ME
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Zip | 04217-1187
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Country | US
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Telephone | 207-595-9978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC3824
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License Number State | ME
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