Healthcare Provider Details

I. General information

NPI: 1336258250
Provider Name (Legal Business Name): MICHAEL J BUXTON & ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 INDEPENDENCE BLVD SUITE 309
VIRGINIA BEACH VA
23455-5500
US

IV. Provider business mailing address

PO BOX 68123
VIRGINIA BEACH VA
23471-8123
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-2666
  • Fax: 757-552-0089
Mailing address:
  • Phone: 757-490-2666
  • Fax: 757-552-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. MICHAEL JAY BUXTON
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: ED.D.
Phone: 757-490-2666