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General NPI Number Information
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NPI Number | 1033655568
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Entity Type | Individual
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Provider Name | NAQUIELA BUCKNER I CMA, MFT
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Gender | Female
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Dates
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Enumeration Date | 01/08/2017
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1780 VERNON ST
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City | ROSEVILLE
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State | CA
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Zip | 95678-6311
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Country | US
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Telephone | 916-782-1111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone | 800-470-0071
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Fax | 916-854-6769
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC7878
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT119229
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License Number State | CA
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