Provider Demographics
NPI:1235278581
Name:BUCKLEY, BONNY JEAN-CRANFORD (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:BONNY
Middle Name:JEAN-CRANFORD
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 E LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3336
Mailing Address - Country:US
Mailing Address - Phone:336-841-6083
Mailing Address - Fax:336-841-6330
Practice Address - Street 1:1124 E LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3336
Practice Address - Country:US
Practice Address - Phone:336-841-6083
Practice Address - Fax:336-841-6330
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 4823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102416Medicaid