Provider Demographics
NPI:1548974595
Name:BANKS, BRIANNA RENEE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:RENEE
Last Name:BANKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:RENEE
Other - Last Name:SCANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:1086 THE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-7042
Mailing Address - Country:US
Mailing Address - Phone:276-207-1869
Mailing Address - Fax:
Practice Address - Street 1:106 SOUTHPARK DR STE C
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6809
Practice Address - Country:US
Practice Address - Phone:571-934-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014789101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor