Individual
EARL DWAYNE BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4611 RIVER HILL CIR, ELLENWOOD, GA 30294-1884
(678) 464-3275
Mailing address
4611 RIVER HILL CIR, ELLENWOOD, GA 30294-1884
(678) 464-3275
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC001765
GA
Other
Enumeration date
03/16/2022
Last updated
03/16/2022
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