Provider Demographics
NPI:1598061855
Name:BUCHANAN, TIA D (DMIN, LCCC, NCC, LP)
Entity Type:Individual
Prefix:DR
First Name:TIA
Middle Name:D
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:DMIN, LCCC, NCC, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 OXFORD ST STE A
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3300
Mailing Address - Country:US
Mailing Address - Phone:803-565-3878
Mailing Address - Fax:877-828-9472
Practice Address - Street 1:531 OXFORD ST STE A
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-565-3878
Practice Address - Fax:877-828-9472
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13741101YP1600X
SC6810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13741OtherLICENSED CLINICAL CHRISTIAN COUNSELOR NCCA
SCPC1931Medicaid