Provider Demographics
NPI:1023451978
Name:BUXTON, WILLIE MAE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:WILLIE
Middle Name:MAE
Last Name:BUXTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22555 STAUNTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3421
Mailing Address - Country:US
Mailing Address - Phone:124-883-5029
Mailing Address - Fax:
Practice Address - Street 1:22555 STAUNTON ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3421
Practice Address - Country:US
Practice Address - Phone:248-835-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010677661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical