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General NPI Number Information
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NPI Number | 1245658830
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Entity Type | Individual
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Provider Name | JEFFERY BANKS LICDC
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Gender | Male
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 830 EZZARD CHARLES DR
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City | CINCINNATI
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State | OH
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Zip | 45214-2525
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Country | US
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Telephone | 513-381-6672
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 SPRINGWATER CT
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City | CINCINNATI
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State | OH
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Zip | 45215-1164
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Country | US
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Telephone | 513-578-1699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 121032
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC162151
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License Number State | OH
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