Provider Demographics
NPI:1821386160
Name:BANKS, JOHANNA NICOLE (PLCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:NICOLE
Last Name:BANKS
Suffix:
Gender:F
Credentials:PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10936 SAND RIVER CT
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9512
Mailing Address - Country:US
Mailing Address - Phone:704-657-9217
Mailing Address - Fax:
Practice Address - Street 1:10225 HICKORYWOOD HILL AVE STE B
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3431
Practice Address - Country:US
Practice Address - Phone:704-657-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0054501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical