Provider Demographics
NPI:1851998975
Name:BUCHANAN, MIKAYLA RENEE (LCHMCA)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:RENEE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LCHMCA
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 524
Mailing Address - Street 2:
Mailing Address - City:TUCKASEGEE
Mailing Address - State:NC
Mailing Address - Zip Code:28783-0524
Mailing Address - Country:US
Mailing Address - Phone:828-506-0801
Mailing Address - Fax:
Practice Address - Street 1:1482 RUSS AVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-4143
Practice Address - Country:US
Practice Address - Phone:828-452-1395
Practice Address - Fax:828-452-1396
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health