Individual provider · Type 1 NPI

Antanique Revesha Edmonds Buckley, LICSW, LCSW

Clinical Social Worker · Columbia, MD

NPI number 1811374465 Active

Practice location

9868 Softwater Way
Columbia, MD 21046-1825

Call (443) 583-4421 Map

Other practice locations

  • 7850 Contee Rd Apt 483, Laurel, MD 20707-9268 · (810) 610-4190
  • 2702 Flushing Rd, Flint, MI 48504-4534 · (810) 424-5998

Specialties and licenses

TaxonomyCodeLicense
Social Worker 104100000X6801096954 (MI)
Clinical Social Worker 1041C0700XLC500825825 (DC)
Clinical Social Worker 1041C0700X0904014720 (VA)
Clinical Social Worker 1041C0700XNone listed
Clinical Social Worker Primary 1041C0700X26173 (MD)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1811374465

Antanique Revesha Edmonds Buckley, LICSW, LCSW's National Provider Identifier is 1811374465, issued on May 4, 2015. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Columbia, MD. The record was last updated on Apr 1, 2023.