Provider Demographics
NPI:1679363386
Name:BUCHANAN, VERONICA (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-0011
Mailing Address - Country:US
Mailing Address - Phone:209-609-3337
Mailing Address - Fax:
Practice Address - Street 1:1545 SAINT MARKS PLZ
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6454
Practice Address - Country:US
Practice Address - Phone:209-460-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist