Provider Demographics
NPI:1295287274
Name:BANKS, SHAKORA H (PHD, LCPC)
Entity type:Individual
Prefix:
First Name:SHAKORA
Middle Name:H
Last Name:BANKS
Suffix:
Gender:M
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11670 OLD NATIONAL PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6121
Mailing Address - Country:US
Mailing Address - Phone:301-865-2226
Mailing Address - Fax:301-865-6720
Practice Address - Street 1:11670 OLD NATIONAL PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6121
Practice Address - Country:US
Practice Address - Phone:301-865-2226
Practice Address - Fax:301-865-6720
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional