Healthcare Provider Details

I. General information

NPI: 1720903362
Provider Name (Legal Business Name): GEREKA BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S WESTGATE DR STE G-J
GREENSBORO NC
27407-1675
US

IV. Provider business mailing address

207 S WESTGATE DR STE G-J
GREENSBORO NC
27407-1675
US

V. Phone/Fax

Practice location:
  • Phone: 336-273-9611
  • Fax:
Mailing address:
  • Phone: 336-273-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: