Provider Demographics
NPI:1700909686
Name:BANK, PATRICIA G (PHD, LISW-CP)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:G
Last Name:BANK
Suffix:
Gender:F
Credentials:PHD, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 LANDMARK DR STE 204A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4034
Mailing Address - Country:US
Mailing Address - Phone:803-360-3376
Mailing Address - Fax:
Practice Address - Street 1:3710 LANDMARK DR STE 204A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4034
Practice Address - Country:US
Practice Address - Phone:803-360-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
SC60911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6091Medicaid