Provider Demographics
NPI:1104490499
Name:BANKS, ADIA (LCSW)
Entity type:Individual
Prefix:
First Name:ADIA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E BYRON NELSON BLVD UNIT 184
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6210
Mailing Address - Country:US
Mailing Address - Phone:972-885-7097
Mailing Address - Fax:
Practice Address - Street 1:11216 BULL HEAD LN
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-1916
Practice Address - Country:US
Practice Address - Phone:972-885-7097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical