MEDICARE: MR. WILLIAM MCGOWAN BANKS III LCSW, CSOTP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904006688	VA

General Provider Information

NPI Number	:	1467621581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM MCGOWAN BANKS III LCSW, CSOTP

Provider Business Mailing Address
First Line	:	1304 PLANTATION RD NE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24012-5713
Country	:	US
Telephone Number	:	540-344-7042
Fax Number	:	540-344-7162

Provider Business Practice Location Address
First Line	:	1304 PLANTATION RD NE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24012-5713
Country	:	US
Telephone Number	:	540-344-7042
Fax Number	:	540-344-7162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/22/2008

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