Provider Demographics
NPI:1114533189
Name:BANKS, CAROL EVELYN FRISKE (LBSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:EVELYN FRISKE
Last Name:BANKS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48804-0800
Mailing Address - Country:US
Mailing Address - Phone:989-773-6904
Mailing Address - Fax:989-772-5339
Practice Address - Street 1:107 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2503
Practice Address - Country:US
Practice Address - Phone:989-773-6904
Practice Address - Fax:989-772-5339
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802066969104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker