Provider Demographics
NPI:1518268572
Name:MARCHBANKS, WILMA JEAN (AA)
Entity Type:Individual
Prefix:MISS
First Name:WILMA
Middle Name:JEAN
Last Name:MARCHBANKS
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 LOR LN NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4791
Mailing Address - Country:US
Mailing Address - Phone:971-388-6211
Mailing Address - Fax:503-399-0679
Practice Address - Street 1:4285 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4371
Practice Address - Country:US
Practice Address - Phone:503-399-7474
Practice Address - Fax:503-399-0679
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral