Provider Demographics
NPI:1962671131
Name:BUCHANAN, KEISHA LATONYA (LPC)
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:LATONYA
Last Name:BUCHANAN
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 1:135 BRADFORD SQ STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1902
Mailing Address - Country:US
Mailing Address - Phone:678-489-8072
Mailing Address - Fax:404-537-1045
Practice Address - Street 1:135 BRADFORD SQ STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1902
Practice Address - Country:US
Practice Address - Phone:678-489-8072
Practice Address - Fax:404-537-1045
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005425101YP2500X
GAAPC001712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional