Provider Demographics
NPI:1083064778
Name:BANKS-GRASTY, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BANKS-GRASTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17715 BRADY
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2117
Mailing Address - Country:US
Mailing Address - Phone:888-473-2408
Mailing Address - Fax:
Practice Address - Street 1:17715 BRADY
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2117
Practice Address - Country:US
Practice Address - Phone:888-473-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010140901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical