Healthcare Provider Details

I. General information

NPI: 1407404213
Provider Name (Legal Business Name): ALLISON BANKSTON MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E HOWRY AVE
DELAND FL
32724-5516
US

IV. Provider business mailing address

486 LAKE GEORGE RD
SEVILLE FL
32190-7906
US

V. Phone/Fax

Practice location:
  • Phone: 386-307-8782
  • Fax:
Mailing address:
  • Phone: 386-307-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10007335
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01213900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17232
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number46.009720
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC11102
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: