Individual
JUDY A BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LCAC, SAP
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001400A
IN
1041C0700X
Clinical Social Worker
Primary
34004283A
IN
Other
Enumeration date
04/09/2013
Last updated
04/29/2016
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