Provider Demographics
NPI:1154912178
Name:BANKS, MARCUS L
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:L
Last Name:BANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 NC HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:NC
Mailing Address - Zip Code:27832-9101
Mailing Address - Country:US
Mailing Address - Phone:919-414-2205
Mailing Address - Fax:
Practice Address - Street 1:2616 NC HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:NC
Practice Address - Zip Code:27832-9101
Practice Address - Country:US
Practice Address - Phone:919-414-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health