Healthcare Provider Details

I. General information

NPI: 1467706176
Provider Name (Legal Business Name): ERIC BANKS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DANNON VW SW STE 3202
ATLANTA GA
30331-2157
US

IV. Provider business mailing address

4132 ATLANTA HWY STE 110-224
LOGANVILLE GA
30052-4930
US

V. Phone/Fax

Practice location:
  • Phone: 404-346-3471
  • Fax:
Mailing address:
  • Phone: 678-288-6550
  • Fax: 678-288-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: