Provider Demographics
NPI:1033398003
Name:BANKS, SHERVONNE (LCSW, MSG)
Entity Type:Individual
Prefix:MS
First Name:SHERVONNE
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW, MSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 CLAIBORNE SQ E STE 334
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2074
Mailing Address - Country:US
Mailing Address - Phone:844-702-4357
Mailing Address - Fax:757-866-5572
Practice Address - Street 1:4410 CLAIBORNE SQ E STE 334
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2074
Practice Address - Country:US
Practice Address - Phone:844-702-4357
Practice Address - Fax:757-866-5572
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61177195104100000X
CT121041041C0700X
CT1215041041C0700X
VA112160305S00000X
VA09040143961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No305S00000XManaged Care OrganizationsPoint of Service