Provider Demographics
NPI:1578031191
Name:CARLA BUTLER, LCSW, PLLC
Entity type:Organization
Organization Name:CARLA BUTLER, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-403-0119
Mailing Address - Street 1:317 OFFICE SQUARE LN STE B101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3652
Mailing Address - Country:US
Mailing Address - Phone:757-403-0119
Mailing Address - Fax:
Practice Address - Street 1:317 OFFICE SQUARE LN STE B101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3652
Practice Address - Country:US
Practice Address - Phone:757-403-0119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty