Provider Demographics
NPI:1437913431
Name:BUCKNER, YVETTE DENISE (RADT)
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:DENISE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 ANTELOPE RD APT 169
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-3959
Mailing Address - Country:US
Mailing Address - Phone:916-907-4631
Mailing Address - Fax:
Practice Address - Street 1:3600 POWER INN RD STE C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3826
Practice Address - Country:US
Practice Address - Phone:916-450-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1547000224101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty