Provider Demographics
NPI:1750512083
Name:BANKSTON, WILLIAM CALVIT JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CALVIT
Last Name:BANKSTON
Suffix:JR
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 1:1779 POLLARD PKWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-8855
Mailing Address - Country:US
Mailing Address - Phone:225-766-8891
Mailing Address - Fax:
Practice Address - Street 1:242 WEST SHAMROCK
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6874
Practice Address - Fax:318-484-6232
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical