Provider Demographics
NPI:1497065130
Name:BUFKIN, TERRA MARISA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:MARISA
Last Name:BUFKIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 SMOKEY WREATH WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5944
Mailing Address - Country:US
Mailing Address - Phone:240-565-7544
Mailing Address - Fax:
Practice Address - Street 1:4626 SMOKEY WREATH WAY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5944
Practice Address - Country:US
Practice Address - Phone:240-565-7544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical