Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2165 | AL |
N | 103T00000X | Psychologist | 2165 | AL |
Y | 103TC1900X | Counseling Psychologist |
NPI | 1043726482 |
---|---|
Provider Name | Dr. Chenetra D Buchannon |
First Address | Auburn, AL 36830-1912 |
Second Address | Tuskegee, AL 36083-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2017 |
Last Update Date | 03/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1487282620 | PRIVATE PRACTICE (01) | AL |