Provider Demographics
NPI:1659183275
Name:PARKS, KEESHA (LGPC)
Entity type:Individual
Prefix:MS
First Name:KEESHA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 GRAND CENTRAL AVE APT 321
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4073
Mailing Address - Country:US
Mailing Address - Phone:443-915-0794
Mailing Address - Fax:
Practice Address - Street 1:6 RESERVOIR CIR STE 206
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-7300
Practice Address - Country:US
Practice Address - Phone:443-835-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional