Healthcare Provider Details

I. General information

NPI: 1518886571
Provider Name (Legal Business Name): BRIAN BANKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 WOODRUFF RD # 1215
SIMPSONVILLE SC
29681-4803
US

IV. Provider business mailing address

2607 WOODRUFF RD # 1215
SIMPSONVILLE SC
29681-4803
US

V. Phone/Fax

Practice location:
  • Phone: 864-743-0060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11930
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11930
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: