Provider Demographics
NPI:1841978749
Name:BANKSTON, HOLLY ANNETTE (LPC & LCDC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANNETTE
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:LPC & LCDC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANNETTE
Other - Last Name:SHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC & LCDC
Mailing Address - Street 1:4204 S MERIDIAN GREENS DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8367
Mailing Address - Country:US
Mailing Address - Phone:409-739-8471
Mailing Address - Fax:
Practice Address - Street 1:4204 S MERIDIAN GREENS DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8367
Practice Address - Country:US
Practice Address - Phone:409-739-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12793101YA0400X
TX71584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)