Healthcare Provider Details

I. General information

NPI: 1407746944
Provider Name (Legal Business Name): RAVEN AYANNA BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 FLOYD LN
GASTONIA NC
28052-5444
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-866-6096
  • Fax: 980-888-0323
Mailing address:
  • Phone: 704-730-7003
  • Fax: 704-865-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022342
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: