Provider Demographics
NPI:1962897793
Name:PARKER, CAROL LUCILLE (PHD LPCC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LUCILLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHD LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:GLORIETA
Mailing Address - State:NM
Mailing Address - Zip Code:87535-0544
Mailing Address - Country:US
Mailing Address - Phone:505-235-1284
Mailing Address - Fax:
Practice Address - Street 1:1600 LENA ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3891
Practice Address - Country:US
Practice Address - Phone:505-235-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health