Provider Demographics
NPI:1245700673
Name:BANKSTON, FELICIA ALEJA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:ALEJA
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 G ST
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4328
Mailing Address - Country:US
Mailing Address - Phone:775-287-0263
Mailing Address - Fax:
Practice Address - Street 1:1780 GAULT WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1824
Practice Address - Country:US
Practice Address - Phone:775-287-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor