Provider Demographics
NPI:1962692509
Name:BANKSTON, ANTOINETTE Q (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:Q
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:BANKSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8180 JOOR RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-6219
Mailing Address - Country:US
Mailing Address - Phone:225-262-4205
Mailing Address - Fax:
Practice Address - Street 1:626 EAST BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6011
Practice Address - Country:US
Practice Address - Phone:225-270-0672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2791OtherLICENSE