Provider Demographics
NPI:1972889624
Name:BUCKNER, SHARON DENISE (LPC-P-LCAS)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DENISE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LPC-P-LCAS
Other - Prefix:MS
Other - First Name:SD
Other - Middle Name:
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC-LCAS
Mailing Address - Street 1:2315 BETHANY BROOK LN APT 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4863
Mailing Address - Country:US
Mailing Address - Phone:980-355-0623
Mailing Address - Fax:
Practice Address - Street 1:2315 BETHANY BROOK LN APT 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4863
Practice Address - Country:US
Practice Address - Phone:980-355-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3914Medicaid