Provider Demographics
NPI:1215537030
Name:BUTZ, DOMINIQUE (LPC, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:
Last Name:BUTZ
Suffix:
Gender:F
Credentials:LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3556
Mailing Address - Country:US
Mailing Address - Phone:610-357-1665
Mailing Address - Fax:
Practice Address - Street 1:100 YEARSLEY MILL ROAD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:484-227-1569
Practice Address - Fax:484-227-1406
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor