Provider Demographics
NPI:1336578384
Name:PARKER, VANESSA (LPC, LADC, CAC)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPC, LADC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3727
Mailing Address - Country:US
Mailing Address - Phone:860-262-2932
Mailing Address - Fax:
Practice Address - Street 1:192 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3727
Practice Address - Country:US
Practice Address - Phone:860-262-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1044101YA0400X
CT3193101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)