Individual
KIMBERLEY YVONNE BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
300 W HOSPITAL RD, FT EISENHOWER, GA 30905-5741
(706) 787-8656
Mailing address
3994 MADISON LN, AUGUSTA, GA 30909-9215
(706) 836-2649
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC010936
GA
Other
Enumeration date
09/22/2019
Last updated
12/20/2023
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