Provider Demographics
NPI:1265125793
Name:BUCKNER, BRENDA L (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BREE
Other - Middle Name:L
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:503 PADENREICH AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-2931
Mailing Address - Country:US
Mailing Address - Phone:256-399-9287
Mailing Address - Fax:
Practice Address - Street 1:2025 3RD AVE N STE 204
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3331
Practice Address - Country:US
Practice Address - Phone:205-957-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional