Healthcare Provider Details

I. General information

NPI: 1396297271
Provider Name (Legal Business Name): STEPHANIE BANKS LPC, LAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 CAMELLIA DR
SLIDELL LA
70458-4229
US

IV. Provider business mailing address

2964 CAMELLIA DR
SLIDELL LA
70458-4229
US

V. Phone/Fax

Practice location:
  • Phone: 985-260-2068
  • Fax: 985-317-0139
Mailing address:
  • Phone: 985-415-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5033
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7124
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: