Provider Demographics
NPI:1992450258
Name:BANKS, TIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:TIA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3642 HARBOR CREST WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5036
Mailing Address - Country:US
Mailing Address - Phone:760-586-5569
Mailing Address - Fax:
Practice Address - Street 1:3642 HARBOR CREST WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5036
Practice Address - Country:US
Practice Address - Phone:760-586-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2389901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical