Individual
DR. IVA JILL BANKS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
300 E COLLEGE AVE, HARTSVILLE, SC 29550-3742
(843) 383-8099
Mailing address
412 W COLLEGE AVE, HARTSVILLE, SC 29550-4120
(843) 383-4746
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
524
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1080
PROFESSIONAL COUNSELOR SU
SC
01
—
254
LICENSED COUNSELING PSYCH
SC
05
—
PS0119
—
SC
Enumeration date
05/09/2006
Last updated
07/09/2007
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