Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 783 | SC |
NPI | 1013049881 |
---|---|
Provider Name | Dr. Fayth Margaret Parks |
First Address | Statesboro, GA 30461-2742 |
Second Address | Statesboro, GA 30461-2742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS0326 | (05) | SC |