Provider Demographics
NPI:1255445466
Name:BUCKNER, CARLA ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:ANN
Last Name:BUCKNER
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:PO BOX 2185
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2185
Mailing Address - Country:US
Mailing Address - Phone:775-722-6681
Mailing Address - Fax:775-887-0466
Practice Address - Street 1:407 N WALSH ST
Practice Address - Street 2:CARSON PROFESSIONAL GROUP
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4268
Practice Address - Country:US
Practice Address - Phone:775-722-6681
Practice Address - Fax:775-887-0466
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01488-C1041C0700X
NMI-064741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical