Basic Information
| Provider Information | |||||||||
| NPI: | 1568902328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUFFINGTON-DEMARCO | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M. ED., LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 SLEEPY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | HEDGESVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254273012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042610267 | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 S WATER ST | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254014241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042638954 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2017 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2266 | WV | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 2266 | WV | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 2266 | WV | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 2266 | WV | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YS0200X | 2266 | WV | N | Behavioral Health & Social Service Providers | Counselor | School | 106H00000X | 2266 | WV | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.