Provider Demographics
NPI:1396088456
Name:WILBANKS, ROBERTA CHRISTIANA (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:CHRISTIANA
Last Name:WILBANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:CHRISTIANA
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:816 E OLDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5567
Mailing Address - Country:US
Mailing Address - Phone:865-523-9163
Mailing Address - Fax:
Practice Address - Street 1:816 E OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5567
Practice Address - Country:US
Practice Address - Phone:865-523-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9655104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ056029Medicaid