Provider Demographics
NPI:1902064405
Name:PARKS, VENESSA JEAN
Entity Type:Individual
Prefix:
First Name:VENESSA
Middle Name:JEAN
Last Name:PARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VENESSA
Other - Middle Name:JEAN
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BPSY
Mailing Address - Street 1:8718 OAKLAND
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48211
Mailing Address - Country:US
Mailing Address - Phone:313-823-6559
Mailing Address - Fax:313-824-0696
Practice Address - Street 1:8718 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-1241
Practice Address - Country:US
Practice Address - Phone:313-823-6559
Practice Address - Fax:313-824-0696
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health