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Individual

ANTANIQUE REVESHA EDMONDS BUCKLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LICSW, LCSW

Contact information

Practice address
9868 SOFTWATER WAY, COLUMBIA, MD 21046-1825
(443) 583-4421
Mailing address
9868 SOFTWATER WAY, COLUMBIA, MD 21046-1825
(443) 583-4421

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
6801096954
MI
1041C0700X
Clinical Social Worker
0904014720
VA
1041C0700X
Clinical Social Worker
Primary
26173
MD
1041C0700X
Clinical Social Worker
LC500825825
DC
1041C0700X
Clinical Social Worker

Other

Enumeration date
05/04/2015
Last updated
04/01/2023
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