Provider Demographics
NPI:1093064347
Name:BANKS, ARDA R (MS)
Entity Type:Individual
Prefix:MRS
First Name:ARDA
Middle Name:R
Last Name:BANKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 SW MOONLITE CV
Mailing Address - Street 2:PO BOX 880187
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2010
Mailing Address - Country:US
Mailing Address - Phone:772-828-0693
Mailing Address - Fax:
Practice Address - Street 1:1288 SW MOONLITE CV
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2010
Practice Address - Country:US
Practice Address - Phone:772-828-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health