Provider Demographics
NPI:1780301390
Name:BANKSTON, LINDA JO (AADC, LADAC, LMSW,)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JO
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:AADC, LADAC, LMSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W H ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3426
Mailing Address - Country:US
Mailing Address - Phone:479-970-6454
Mailing Address - Fax:
Practice Address - Street 1:200 N 3RD ST
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3802
Practice Address - Country:US
Practice Address - Phone:479-229-4677
Practice Address - Fax:479-229-6155
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12637-M104100000X
AR459L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker