Provider Demographics
NPI:1003972563
Name:BUFFKIN, THOMAS R (LPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:BUFFKIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 N ELM ST APT A4
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1431
Mailing Address - Country:US
Mailing Address - Phone:336-580-1766
Mailing Address - Fax:
Practice Address - Street 1:1013 N ELM ST APT A4
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1431
Practice Address - Country:US
Practice Address - Phone:336-272-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102386Medicaid