MEDICARE: MR. DASHUN TYRELL BANKS NCLPCBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101Y00000X	Counselor
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1972821916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DASHUN TYRELL BANKS NCLPCBE

Provider Business Mailing Address
First Line	:	100 LINCOLN RD APT 921
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2013
Country	:	US
Telephone Number	:	919-672-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 UNION ST S # LL207
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-5059
Country	:	US
Telephone Number	:	919-672-5005
Fax Number	:	800-806-0750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	08/03/2022

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