Provider Demographics
NPI:1588948822
Name:BUCKNER, DEBRA DENISE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DENISE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N TACOMA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3512
Mailing Address - Country:US
Mailing Address - Phone:317-259-7122
Mailing Address - Fax:317-259-7167
Practice Address - Street 1:5555 N TACOMA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3512
Practice Address - Country:US
Practice Address - Phone:317-259-7122
Practice Address - Fax:317-259-7167
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000697-A101YA0400X
IN34002010-A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical