Provider Demographics
NPI:1932813888
Name:BANKS, ANGELICA DENISE
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:DENISE
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 FRIEDBERG CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9803
Mailing Address - Country:US
Mailing Address - Phone:336-251-1180
Mailing Address - Fax:
Practice Address - Street 1:307B E SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5213
Practice Address - Country:US
Practice Address - Phone:336-965-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000027433597106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician