Provider Demographics
NPI:1811237134
Name:HALE-BANKS, LEQUANDRA RANIECE (LCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:LEQUANDRA
Middle Name:RANIECE
Last Name:HALE-BANKS
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 SUDBURY LN APT 202
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-3335
Mailing Address - Country:US
Mailing Address - Phone:901-612-4359
Mailing Address - Fax:888-721-4071
Practice Address - Street 1:3721 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115
Practice Address - Country:US
Practice Address - Phone:901-334-3144
Practice Address - Fax:901-334-3145
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0061151041C0700X
TN65381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046933Medicaid
GA003151522AMedicaid
TNQ063320281OtherMEDICARE