Provider Demographics
NPI:1306296314
Name:PARRIS JACQUES, KISHA (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:KISHA
Middle Name:
Last Name:PARRIS JACQUES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8662 PULPIT HARBOUR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2539
Mailing Address - Country:US
Mailing Address - Phone:718-772-2261
Mailing Address - Fax:
Practice Address - Street 1:8662 PULPIT HARBOUR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2539
Practice Address - Country:US
Practice Address - Phone:718-772-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14567101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health