MEDICARE: MORGAN CHARNECE PARKS LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	5608C	AL

General Provider Information

NPI Number	:	1366293094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN CHARNECE PARKS LICSW

Provider Business Mailing Address
First Line	:	101 LEAF LAKE BLVD APT 918
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35211-7257
Country	:	US
Telephone Number	:	707-208-8953
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 LEAF LAKE BLVD APT 918
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35211-7257
Country	:	US
Telephone Number	:	707-208-8953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	03/29/2024

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