Provider Demographics
NPI:1336901768
Name:WILBANKS, DUNCAN
Entity type:Individual
Prefix:
First Name:DUNCAN
Middle Name:
Last Name:WILBANKS
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 1:101 FOREST PARK CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5801
Mailing Address - Country:US
Mailing Address - Phone:863-899-5168
Mailing Address - Fax:
Practice Address - Street 1:101 FOREST PARK CT
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5801
Practice Address - Country:US
Practice Address - Phone:863-899-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health