Provider Demographics
NPI:1043726482
Name:BUCHANNON, CHENETRA D (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHENETRA
Middle Name:D
Last Name:BUCHANNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 ROANOKE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-1912
Mailing Address - Country:US
Mailing Address - Phone:334-707-7362
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL RD # 4A-209
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-5001
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-3262
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
AL2165103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1487282620OtherPRIVATE PRACTICE