Provider Demographics
NPI:1457732596
Name:ELLER, BUFFIE BAKER (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:BUFFIE
Middle Name:BAKER
Last Name:ELLER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2763 NC HIGHWAY 150 EAST
Mailing Address - Street 2:
Mailing Address - City:LICOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7615
Mailing Address - Country:US
Mailing Address - Phone:704-735-2050
Mailing Address - Fax:
Practice Address - Street 1:2005 FLINT LANE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-865-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health