Provider Demographics
NPI:1134746654
Name:BANKS, KEISHA T (LCSW)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:T
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 MEADOWGATE LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8372
Mailing Address - Country:US
Mailing Address - Phone:704-807-9842
Mailing Address - Fax:
Practice Address - Street 1:1353 MEADOWGATE LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-8372
Practice Address - Country:US
Practice Address - Phone:704-807-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0106911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical