Provider Demographics
NPI:1366916447
Name:BANKS, CHELSEA (MMFT, LCAS-A)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:MMFT, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 MARVELLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-2328
Mailing Address - Country:US
Mailing Address - Phone:610-360-6802
Mailing Address - Fax:
Practice Address - Street 1:3208 SUNSET AVE STE B
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3590
Practice Address - Country:US
Practice Address - Phone:252-212-5524
Practice Address - Fax:252-212-5844
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25105101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty