Provider Demographics
NPI:1073916524
Name:BANKS, EUNICE (LMSW)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:EUNICE
Other - Middle Name:CAROLYN
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:19115 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2706
Mailing Address - Country:US
Mailing Address - Phone:313-255-6000
Mailing Address - Fax:313-255-0051
Practice Address - Street 1:19115 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2706
Practice Address - Country:US
Practice Address - Phone:313-255-6000
Practice Address - Fax:313-255-0051
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010944171041C0700X
GACSW0052401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical