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Provider Information for 1689089377


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WANDA PARKER MA, CADC, LCPC


Sex: Female

NPI: 1689089377
Last Updated: 2023-03-14
Certification Date: 2023-03-14

Details

NameValue
NPI1689089377
Enumeration Date2014-06-22
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 14710 CENTRAL AVE
APARTMENT C319
OAK FOREST, IL 60452-1252
United States

Phone: 773-575-9631 | Fax:
 
Primary Practice Address 14710 CENTRAL AVE
APARTMENT C319
OAK FOREST, IL 60452-1252
United States

Phone: 773-575-9631 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YA0400X - Counselor - Addiction (Substance Use Disorder)IL21216
No 101YM0800X - Counselor - Mental Health
Yes 101YP2500X - Counselor - ProfessionalIL180.010540