Provider Demographics
NPI:1295079291
Name:BANKS, KELVIN LAMARR (MA, MSW, LLMSW, CTS)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:LAMARR
Last Name:BANKS
Suffix:
Gender:M
Credentials:MA, MSW, LLMSW, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28448 WESTERLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3472
Mailing Address - Country:US
Mailing Address - Phone:313-613-0856
Mailing Address - Fax:
Practice Address - Street 1:28448 WESTERLEIGH RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3472
Practice Address - Country:US
Practice Address - Phone:313-613-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010941951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical