Provider Information for 1841978749
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HOLLY ANNETTE BANKSTON LPC & LCDC
Other Names:Former Name:HOLLY ANNETTE SHEAD LPC & LCDCSex: Female
NPI: 1841978749
Last Updated: 2023-07-10
Certification Date: 2023-07-10
Certification Date: 2023-07-10
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1841978749 | ||||||||||||
| Enumeration Date | 2023-07-10 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4204 S MERIDIAN GREENS DR DICKINSON, TX 77539-8367 United States Phone: 409-739-8471 | Fax: | ||||||||||||
| Primary Practice Address | 4204 S MERIDIAN GREENS DR DICKINSON, TX 77539-8367 United States Phone: 409-739-8471 | Fax: | ||||||||||||
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