Individual
ANTANIQUE REVESHA EDMONDS BUCKLEY
Active
Individual
ANTANIQUE REVESHA EDMONDS BUCKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW, LCSW
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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