Healthcare Provider Details

I. General information

NPI: 1538596580
Provider Name (Legal Business Name): HASINA BANKSTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 FULLER AVE NE STE 208
GRAND RAPIDS MI
49505-3458
US

IV. Provider business mailing address

3373 SANDYHOOK CT SE
KENTWOOD MI
49512-5281
US

V. Phone/Fax

Practice location:
  • Phone: 616-551-2916
  • Fax: 616-383-9009
Mailing address:
  • Phone: 616-885-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801096020
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: