Provider Demographics
NPI:1639586878
Name:BANKSTON, ASHTIN (LMSW)
Entity Type:Individual
Prefix:
First Name:ASHTIN
Middle Name:
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ASHTIN
Other - Middle Name:
Other - Last Name:ANIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:4615 GOVERNMENT ST
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5922
Mailing Address - Country:US
Mailing Address - Phone:225-922-0445
Mailing Address - Fax:225-922-2658
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:BUILDING 1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5922
Practice Address - Country:US
Practice Address - Phone:225-922-0445
Practice Address - Fax:225-922-2658
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12883101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool