Individual
MS. ELISA MICHELLE BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
4560 SOUTH BLVD STE 310, VIRGINIA BEACH, VA 23452-1160
(757) 716-8830
Mailing address
9638 10TH VIEW ST, APT 4, NORFOLK, VA 23503
(757) 714-3693
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-64710
VA
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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