Provider Demographics
NPI:1639306699
Name:BANKSTON, NANCY CODY (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CODY
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7349
Mailing Address - Country:US
Mailing Address - Phone:770-474-8400
Mailing Address - Fax:
Practice Address - Street 1:275 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7349
Practice Address - Country:US
Practice Address - Phone:770-474-8400
Practice Address - Fax:770-233-2810
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002290101YM0800X
GAMFT001185106H00000X
GALPC006661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist