Provider Demographics
NPI:1881256949
Name:BANKSTON, DENISE JANELLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:JANELLE
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 RUSTIC LIVE OAK TRL
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4230
Mailing Address - Country:US
Mailing Address - Phone:229-583-3385
Mailing Address - Fax:
Practice Address - Street 1:109 OSIGIAN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8924
Practice Address - Country:US
Practice Address - Phone:478-333-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker