Provider Demographics
NPI:1205354776
Name:PARILLON, NAKISHA (LICSW, LADC-1)
Entity type:Individual
Prefix:MRS
First Name:NAKISHA
Middle Name:
Last Name:PARILLON
Suffix:
Gender:F
Credentials:LICSW, LADC-1
Other - Prefix:MS
Other - First Name:NAKISHA
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, LADC-1
Mailing Address - Street 1:500 WESTGATE DR # 1051
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1855
Mailing Address - Country:US
Mailing Address - Phone:781-366-0662
Mailing Address - Fax:
Practice Address - Street 1:500 WESTGATE DR # 1051
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1855
Practice Address - Country:US
Practice Address - Phone:781-366-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19662101YA0400X
OHI.24051521041C0700X
390200000X
MA1247551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.2405152OtherCSWMFT BOARD OF OHIO
MA124755OtherTHE ASSOCIATION OF SOCIAL WORK BOARDS
MA19662OtherBUREAU OF SUBSTANCE ABUSE