Provider Demographics
NPI:1558037788
Name:BUCKLEY, SHERRI L (AMFT)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:AMFT
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 83578
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-9447
Mailing Address - Country:US
Mailing Address - Phone:706-424-5826
Mailing Address - Fax:
Practice Address - Street 1:35 BROOKLINE PKWY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-4111
Practice Address - Country:US
Practice Address - Phone:706-424-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000468106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist