Provider Demographics
NPI:1962164103
Name:PARKS, JAMES HENRY IV (LICSW, MSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HENRY
Last Name:PARKS
Suffix:IV
Gender:M
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 46TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4621
Mailing Address - Country:US
Mailing Address - Phone:202-294-9664
Mailing Address - Fax:
Practice Address - Street 1:4420 BENNING RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4555
Practice Address - Country:US
Practice Address - Phone:202-235-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000029721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical