Healthcare Provider Details

I. General information

NPI: 1457732596
Provider Name (Legal Business Name): BUFFIE BAKER ELLER L.P.C.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 FLINT LANE
GASTONIA NC
28054
US

IV. Provider business mailing address

2763 NC HIGHWAY 150 EAST
LICOLNTON NC
28092-7615
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-4068
  • Fax:
Mailing address:
  • Phone: 704-735-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA8675
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: