Basic Information
| Provider Information | |||||||||
| NPI: | 1467788638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCKNER | ||||||||
| FirstName: | ADRIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 60112 | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177737554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 960 CENTURY DRIVE | ||||||||
| Address2: | DIAKON FAMILY LIFE SERVICE | ||||||||
| City: | MECHANSIBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177950330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2009 | ||||||||
| LastUpdateDate: | 10/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.