Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1597-123 | WI |
NPI | 1003065954 |
---|---|
Provider Name | Ms. Carla D. Banks |
First Address | Fort Carson, CO 80913-4152 |
Second Address | Fort Carson, CO 80913-4152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 16/09/2008 |