Individual
DR. SAMMY F. BANAWAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1411 BROAD ST, DURHAM, NC 27705-3534
(919) 308-8675
Mailing address
1411 BROAD ST, DURHAM, NC 27705-3534
(919) 308-8675
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
3234
NC
103TC0700X
Clinical Psychologist
Primary
3234
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046X7
BCBS PROVIDER NUMBER
NC
Enumeration date
10/13/2006
Last updated
06/06/2011
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