Provider Demographics
NPI:1396119764
Name:PARKS, TERRY LEE (LPC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:PARKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1032 OLD PEACHTREE RD NW
Mailing Address - Street 2:SUITE 401, PMB 147
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3324
Mailing Address - Country:US
Mailing Address - Phone:404-551-5571
Mailing Address - Fax:404-551-5574
Practice Address - Street 1:223 SCENIC HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5603
Practice Address - Country:US
Practice Address - Phone:404-551-5571
Practice Address - Fax:404-551-5574
Is Sole Proprietor?:No
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional