Provider Demographics
NPI:1417474057
Name:BUFFINGTON, SHONTELL (LCSW)
Entity Type:Individual
Prefix:
First Name:SHONTELL
Middle Name:
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64594
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-4594
Mailing Address - Country:US
Mailing Address - Phone:225-366-8766
Mailing Address - Fax:225-208-1800
Practice Address - Street 1:3029 S SHERWOOD FOREST BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2276
Practice Address - Country:US
Practice Address - Phone:225-366-8766
Practice Address - Fax:225-208-1800
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA123961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical