Provider Demographics
NPI:1366552374
Name:BANKSTON, CHARLES W (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:BANKSTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8912 TOWN AND COUNTRY CIR
Mailing Address - Street 2:#6
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4900
Mailing Address - Country:US
Mailing Address - Phone:865-690-7169
Mailing Address - Fax:
Practice Address - Street 1:8912 TOWN AND COUNTRY CIR
Practice Address - Street 2:#6
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4900
Practice Address - Country:US
Practice Address - Phone:865-690-7169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000008721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3699282Medicare PIN