Provider Demographics
NPI:1205185378
Name:BANKS, SHENICKA K (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:SHENICKA
Middle Name:K
Last Name:BANKS
Suffix:
Gender:F
Credentials:MSW, LCSWA
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 1434
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-1434
Mailing Address - Country:US
Mailing Address - Phone:910-317-0646
Mailing Address - Fax:
Practice Address - Street 1:107 S LEE ST # 1434
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4027
Practice Address - Country:US
Practice Address - Phone:910-317-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP007543OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD