Provider Demographics
NPI:1467621581
Name:BANKS, WILLIAM MCGOWAN III (LCSW, CSOTP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MCGOWAN
Last Name:BANKS
Suffix:III
Gender:M
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1304 PLANTATION RD NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-5713
Mailing Address - Country:US
Mailing Address - Phone:540-344-7042
Mailing Address - Fax:540-344-7162
Practice Address - Street 1:1304 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5713
Practice Address - Country:US
Practice Address - Phone:540-344-7042
Practice Address - Fax:540-344-7162
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical