Provider Demographics
NPI:1679773972
Name:BANKS, LEON (LCSW)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:BANKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:NEWBORN
Mailing Address - State:GA
Mailing Address - Zip Code:30056-0036
Mailing Address - Country:US
Mailing Address - Phone:706-714-8977
Mailing Address - Fax:
Practice Address - Street 1:4050 HIGHWAY 142
Practice Address - Street 2:
Practice Address - City:NEWBORN
Practice Address - State:GA
Practice Address - Zip Code:30056-2007
Practice Address - Country:US
Practice Address - Phone:706-714-8977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW032891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical