Healthcare Provider Details

I. General information

NPI: 1306671755
Provider Name (Legal Business Name): EMILY BUCKLEY LCMHCA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 HADDINGTON CT N
WHITSETT NC
27377-9208
US

IV. Provider business mailing address

804 HADDINGTON CT N
WHITSETT NC
27377-9208
US

V. Phone/Fax

Practice location:
  • Phone: 336-312-1397
  • Fax: 336-697-6965
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA20385
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: