Provider Demographics
NPI:1952325706
Name:WHITNER, BANTA H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BANTA
Middle Name:H
Last Name:WHITNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:151 NC HIGHWAY 9
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711
Mailing Address - Country:US
Mailing Address - Phone:904-612-3309
Mailing Address - Fax:904-737-9369
Practice Address - Street 1:402 MONTREAT RD.
Practice Address - Street 2:SOURCE FOR WELL-BEING
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711
Practice Address - Country:US
Practice Address - Phone:904-612-3309
Practice Address - Fax:904-737-9369
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22951041C0700X
NCC0077161041C0700X
FL00022951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical