Provider Demographics
NPI:1588819940
Name:BANKS, VICKI (MA)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5501 N 19TH AVE
Mailing Address - Street 2:310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2450
Mailing Address - Country:US
Mailing Address - Phone:601-433-1344
Mailing Address - Fax:602-249-1570
Practice Address - Street 1:6085 N 85TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2565
Practice Address - Country:US
Practice Address - Phone:623-877-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1381104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator