Provider Demographics
NPI:1619311008
Name:BANKS, SONYA LASHAWN (BS, SST)
Entity Type:Individual
Prefix:MISS
First Name:SONYA
Middle Name:LASHAWN
Last Name:BANKS
Suffix:
Gender:F
Credentials:BS, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38855 HILLS TECH DR
Mailing Address - Street 2:200
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3421
Mailing Address - Country:US
Mailing Address - Phone:248-871-1464
Mailing Address - Fax:248-994-8005
Practice Address - Street 1:38855 HILLS TECH DR
Practice Address - Street 2:200
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3421
Practice Address - Country:US
Practice Address - Phone:248-871-1464
Practice Address - Fax:248-994-8005
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085947171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator