Provider Demographics
NPI:1841778545
Name:BUFKIN, DINAH MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:DINAH
Middle Name:MARIE
Last Name:BUFKIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 GRANBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8534
Mailing Address - Country:US
Mailing Address - Phone:601-383-4849
Mailing Address - Fax:
Practice Address - Street 1:1640 LELIA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4832
Practice Address - Country:US
Practice Address - Phone:601-790-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional