Provider Demographics
NPI:1871819342
Name:BUCHANAN, TALIBAH ESTHER (PHD)
Entity Type:Individual
Prefix:
First Name:TALIBAH
Middle Name:ESTHER
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 GEORGIA AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3614
Mailing Address - Country:US
Mailing Address - Phone:301-495-6393
Mailing Address - Fax:301-495-6394
Practice Address - Street 1:8720 GEORGIA AVE STE 308
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3614
Practice Address - Country:US
Practice Address - Phone:301-495-6393
Practice Address - Fax:301-495-6394
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04471103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist