Provider Demographics
NPI:1912287814
Name:BANKS, THERESA ANN (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:BANKS
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:LIVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 LYNWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2024
Mailing Address - Country:US
Mailing Address - Phone:919-599-5919
Mailing Address - Fax:919-586-7814
Practice Address - Street 1:409 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:RICH SQUARE
Practice Address - State:NC
Practice Address - Zip Code:27869
Practice Address - Country:US
Practice Address - Phone:919-599-5919
Practice Address - Fax:919-586-7814
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPC10451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional