MEDICARE: DEBI C BUCKLAND MS, LMFT, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC006270	GA
2	106H00000X	Marriage & Family Therapist	MFT00196	GA

General Provider Information

NPI Number	:	1184981904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBI C BUCKLAND MS, LMFT, LPC

Provider Business Mailing Address
First Line	:	3334 PEACHTREE RD NE
Second Line	:	#1606
City	:	ATLANTA
State	:	GA
Zip	:	30326-6801
Country	:	US
Telephone Number	:	404-842-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	5881 GLENRIDGE DR NE
Second Line	:	SUITE 240
City	:	ATLANTA
State	:	GA
Zip	:	30328-5301
Country	:	US
Telephone Number	:	404-842-0696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/18/2012

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