Provider Demographics
NPI:1992045512
Name:LICH, BUFFA SINGLETON (RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:BUFFA
Middle Name:SINGLETON
Last Name:LICH
Suffix:
Gender:F
Credentials:RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6224
Mailing Address - Country:US
Mailing Address - Phone:252-758-0721
Mailing Address - Fax:
Practice Address - Street 1:3005 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6224
Practice Address - Country:US
Practice Address - Phone:252-758-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001362133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered