Individual
MRS. ANTOINETTE Q. BANKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
626 EAST BLVD, BATON ROUGE, LA 70802-6011
(225) 270-0672
Mailing address
8180 JOOR RD, BATON ROUGE, LA 70818-6219
(225) 262-4205
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2791
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2791
LICENSE
LA
Enumeration date
07/30/2007
Last updated
07/21/2022
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