Healthcare Provider Details

I. General information

NPI: 1891630919
Provider Name (Legal Business Name): KEITH L BANKS LPC-R, CSAC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 LORI RD.
CHESTERFIELD VA
23832
US

IV. Provider business mailing address

12053 ALMER LN
CHESTER VA
23836-3081
US

V. Phone/Fax

Practice location:
  • Phone: 804-387-3816
  • Fax:
Mailing address:
  • Phone: 804-387-3816
  • Fax: 877-681-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: