Provider Demographics
NPI:1619648565
Name:BUCK, DEMEKA LASHERRY
Entity Type:Individual
Prefix:
First Name:DEMEKA
Middle Name:LASHERRY
Last Name:BUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 BEVERLY P WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-3449
Mailing Address - Country:US
Mailing Address - Phone:251-510-3950
Mailing Address - Fax:
Practice Address - Street 1:1302 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36610-5306
Practice Address - Country:US
Practice Address - Phone:251-510-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL05959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional