Provider Demographics
NPI:1114634953
Name:BUCKLAND, LESA J (MASTERS HS)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:J
Last Name:BUCKLAND
Suffix:
Gender:F
Credentials:MASTERS HS
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 330
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-0330
Mailing Address - Country:US
Mailing Address - Phone:304-222-2263
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 330
Practice Address - Street 2:
Practice Address - City:SHADY SPRING
Practice Address - State:WV
Practice Address - Zip Code:25918-0330
Practice Address - Country:US
Practice Address - Phone:304-222-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVE503327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional