Michaela Buckhannon, LISW CP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14019 Issued in SC

Practice address

171 Ashley Ave
Charleston, SC 29425-5650

Phone

(843) 792-1414

NPI assigned

Feb 3, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Michaela Williams Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tide Life Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Isle of Palms, SC
  • NPI 1356088108
  NPD Authorized official
• Wildflower Center for Counseling

  • Counselor
  • Mount Pleasant, SC
  • NPI 1780229146
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1770174500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294255650",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "268 W Coleman Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "SC",
            "postal_code": "294645650",
            "country_code": "US",
            "telephone_number": "843-936-2566",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4 27th Ave Apt A",
            "address_purpose": "LOCATION",
            "city": "Isle Of Palms",
            "state": "SC",
            "postal_code": "294512402",
            "country_code": "US",
            "telephone_number": "843-603-1213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKHANNON",
        "first_name": "MICHAELA",
        "credential": "LISW CP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-03",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "14019",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "14019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "171 Ashley Ave",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294255650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MICHAELA",
            "last_name": "WILLIAMS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robin L Buchanan, CRNA
• Steven N Buchanan II
• Markus Andrew Buchfellner, MD
• Emerson Buck, MD
• Gregory Franklin Buck, PA-C
• Jason Robert Buckley, M.D.
• Stephen Budd
• Ann Katherine Buddin, PHARMD
• William Howard Buddin Jr., PH.D.
• Budev Eyecare & Surgery, PA

• Clinical Social Worker in Charleston, SC
• Providers in Charleston, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.