Provider Demographics
NPI:1427171164
Name:BANKS, BETTIE SHEPPARD (PHD, ABPP)
Entity type:Individual
Prefix:
First Name:BETTIE
Middle Name:SHEPPARD
Last Name:BANKS
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 HOWELL MILL RD NW
Mailing Address - Street 2:UNIT 13
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1657
Mailing Address - Country:US
Mailing Address - Phone:404-355-9060
Mailing Address - Fax:404-355-9060
Practice Address - Street 1:3075 HOWELL MILL RD NW
Practice Address - Street 2:UNIT 13
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1657
Practice Address - Country:US
Practice Address - Phone:404-355-9060
Practice Address - Fax:404-355-9060
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical