Provider Demographics
NPI:1093495665
Name:BUFORD, CARLA LYNETTE (MSW, CSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LYNETTE
Last Name:BUFORD
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 HEMP HILL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8680
Mailing Address - Country:US
Mailing Address - Phone:859-420-3042
Mailing Address - Fax:
Practice Address - Street 1:501 DARBY CREEK RD STE 62
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2611
Practice Address - Country:US
Practice Address - Phone:859-705-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY257376101Y00000X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker