Provider Demographics
NPI:1508332008
Name:BANKS, ELISA MICHELLE (RBT)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:MICHELLE
Last Name:BANKS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9638 10TH VIEW ST
Mailing Address - Street 2:APT 4
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503
Mailing Address - Country:US
Mailing Address - Phone:757-714-3693
Mailing Address - Fax:
Practice Address - Street 1:4560 SOUTH BLVD STE 310
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1160
Practice Address - Country:US
Practice Address - Phone:757-716-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-18-64710106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician