Individual
ANDREA BANKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2447 SUMMERFIELD RD, SANTA ROSA, CA 95405-7815
(707) 544-3299
Mailing address
1545 BROOKSIDE DR, SANTA ROSA, CA 95405-6643
(707) 583-4672
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
08/18/2017
Last updated
04/01/2019
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