Provider Demographics
NPI:1346333499
Name:VAN BUSKIRK, ETOLIA KNIGHT (LCSW)
Entity Type:Individual
Prefix:
First Name:ETOLIA
Middle Name:KNIGHT
Last Name:VAN BUSKIRK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ETOLIA
Other - Middle Name:
Other - Last Name:VAN BUSKIRK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:148 LAURA DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9121
Mailing Address - Country:US
Mailing Address - Phone:478-396-1395
Mailing Address - Fax:
Practice Address - Street 1:1304 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2212
Practice Address - Country:US
Practice Address - Phone:252-637-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0035881041C0700X
NCC0091671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical