Individual
MR. CHASE TODD BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MDIV MSW LCSW CEDS
Contact information
Practice address
817 BROAD ST, DURHAM, NC 27705-4137
(202) 670-5125
Mailing address
2108 STUART DR, DURHAM, NC 27707-2262
(202) 670-5125
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C006086
NC
Other
Enumeration date
06/23/2008
Last updated
07/21/2022
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