Individual
MR. EDWARD GERARD BUCKENHAM III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
104 E 5TH AVE, ROME, GA 30161-3128
(706) 235-6990
Mailing address
10 ROYAL OAK DR NE, ROME, GA 30165-9331
(706) 295-0440
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
APC001620
GA
101YP2500X
Professional Counselor
Primary
LPC006095
GA
Other
Enumeration date
12/06/2007
Last updated
09/21/2022
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