Provider Demographics
NPI:1760023048
Name:BANKS, RIVER JOSHUA-DAVID (CADC)
Entity Type:Individual
Prefix:MR
First Name:RIVER
Middle Name:JOSHUA-DAVID
Last Name:BANKS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7108
Mailing Address - Country:US
Mailing Address - Phone:207-509-0000
Mailing Address - Fax:
Practice Address - Street 1:105 MIDDLE ST # 3
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7037
Practice Address - Country:US
Practice Address - Phone:207-440-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6990101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECAC6990OtherC ADC