Provider Demographics
NPI:1962048827
Name:BANKS, KIMBERLY CHRISTINA (MFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHRISTINA
Last Name:BANKS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 HUNGARY SPRING RD STE 204
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2425
Mailing Address - Country:US
Mailing Address - Phone:804-322-7333
Mailing Address - Fax:
Practice Address - Street 1:3002 HUNGARY SPRING RD STE 204
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2425
Practice Address - Country:US
Practice Address - Phone:804-322-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3501Medicaid