| NPI | 1205175288 |
|---|---|
| Former Name | SHANNON LYNN BUCKALEW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P006197) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC P006197) |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2013-06-14 |