Provider Demographics
NPI:1255653606
Name:BANKS, IRIS WALDON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:WALDON
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ALEXANDER ST SE
Mailing Address - Street 2:STE. #8
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8217
Mailing Address - Country:US
Mailing Address - Phone:770-783-0124
Mailing Address - Fax:
Practice Address - Street 1:316 ALEXANDER ST SE
Practice Address - Street 2:STE. #8
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8217
Practice Address - Country:US
Practice Address - Phone:770-783-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0041191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical