Individual
JACQUELINE DIANE PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, TLLP
Contact information
Practice address
19291 NORTHLINE RD, SOUTHGATE, MI 48195-2220
(734) 785-7700
Mailing address
2485 W EUCLID ST, DETROIT, MI 48206-2441
(313) 728-5519
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301015305
MI
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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