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Individual
SHAWNA B PARK
Active
Individual
SHAWNA B PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW-S, LCDC III
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10121
OH
1041C0700X
Clinical Social Worker
Primary
I.1101599
OH
Other
Enumeration date
08/30/2012
Last updated
01/21/2015
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