Individual
LACY LONG BUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 FAIRFIELD AVE, SHREVEPORT, LA 71104-2099
(318) 222-8511
(318) 425-9670
Mailing address
2000 FAIRFIELD AVE, SHREVEPORT, LA 71104-2099
(318) 222-8511
(318) 425-9670
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
07/26/2022
Last updated
10/06/2023
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