Provider Demographics
NPI:1508300609
Name:BUFORD, MIYA (LCSWA)
Entity Type:Individual
Prefix:
First Name:MIYA
Middle Name:
Last Name:BUFORD
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10412 HUGUE WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-8856
Mailing Address - Country:US
Mailing Address - Phone:980-307-9538
Mailing Address - Fax:
Practice Address - Street 1:6230 FAIRVIEW RD
Practice Address - Street 2:STE 290
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3258
Practice Address - Country:US
Practice Address - Phone:980-335-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP009807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional