Provider Demographics
NPI:1881151769
Name:PARKS, KATHERINE AMANDA (CAADC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AMANDA
Last Name:PARKS
Suffix:
Gender:F
Credentials:CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 COUNTY ROAD 61
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-4652
Mailing Address - Country:US
Mailing Address - Phone:334-646-9345
Mailing Address - Fax:
Practice Address - Street 1:229 S DAVIS RD STE 900
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2609
Practice Address - Country:US
Practice Address - Phone:706-756-1489
Practice Address - Fax:706-756-1493
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC0291101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)