Provider Demographics
NPI:1033288485
Name:BUCK, CAROLYN GWEN (LPCC, LICDIC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:GWEN
Last Name:BUCK
Suffix:
Gender:F
Credentials:LPCC, LICDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 MCDOWELL ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-3133
Mailing Address - Country:US
Mailing Address - Phone:330-499-1598
Mailing Address - Fax:
Practice Address - Street 1:305 15TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2573
Practice Address - Country:US
Practice Address - Phone:330-454-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health