Provider Demographics
NPI:1609036987
Name:BANJOKO, TONY (MSED LPC)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:
Last Name:BANJOKO
Suffix:
Gender:M
Credentials:MSED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:100 W HEMSTEAD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-2697
Practice Address - Country:US
Practice Address - Phone:336-242-1597
Practice Address - Fax:336-242-1372
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional