Healthcare Provider Details

I. General information

NPI: 1518151372
Provider Name (Legal Business Name): EMILY WILLIFORD BUCKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 POPLARWOOD CT STE 300
RALEIGH NC
27604-1084
US

IV. Provider business mailing address

6032 SAYBROOKE DR
RALEIGH NC
27604-1093
US

V. Phone/Fax

Practice location:
  • Phone: 919-790-8580
  • Fax:
Mailing address:
  • Phone: 619-890-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: