Provider Demographics
NPI:1043956980
Name:BANNING, EDITH (CADC)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:BANNING
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 E MASTEN CIR STE 115
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1268
Mailing Address - Country:US
Mailing Address - Phone:302-856-4700
Mailing Address - Fax:
Practice Address - Street 1:769 E MASTEN CIR STE 115
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1268
Practice Address - Country:US
Practice Address - Phone:302-856-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1913101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)