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General NPI Number Information
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NPI Number | 1396119764
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Entity Type | Individual
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Provider Name | TERRY LEE PARKS LPC
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Gender | Male
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Dates
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Enumeration Date | 11/21/2015
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Last Update Date | 11/21/2015
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Provider Practice Location Address
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Address Line | 223 SCENIC HWY SUITE 103
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5603
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Country | US
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Telephone | 404-551-5571
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Fax | 404-551-5574
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Provider Business Mailing Address
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Address Line | 1032 OLD PEACHTREE RD NW SUITE 401, PMB 147
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3324
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Country | US
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Telephone | 404-551-5571
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Fax | 404-551-5574
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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 | LPC008672
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License Number State | GA
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