Provider Demographics
NPI:1659531457
Name:GREENE-BUCKLAND, LAURA KINSEY (LPC, MA, MS ED)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KINSEY
Last Name:GREENE-BUCKLAND
Suffix:
Gender:F
Credentials:LPC, MA, MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MARINERS POINT LN
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8838
Mailing Address - Country:US
Mailing Address - Phone:828-495-3650
Mailing Address - Fax:828-495-5101
Practice Address - Street 1:112 MARINERS POINT LN
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-8838
Practice Address - Country:US
Practice Address - Phone:828-495-3650
Practice Address - Fax:828-495-5101
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102281Medicaid