Individual
MARLA LYNN BANISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW, CMHP, QMHP
Contact information
Practice address
6211 TAYLOR DR, FLINT, MI 48507-4665
(810) 237-0799
Mailing address
PO BOX 289, MASON, MI 48854-0289
(517) 676-5405
(517) 676-5460
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
6802086581
MI
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/21/2014
Last updated
02/23/2024
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