Provider Demographics
NPI:1235809989
Name:BUTLER, LISA HARRIS (LCAS, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:HARRIS
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCAS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 KILPATRICK RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-9785
Mailing Address - Country:US
Mailing Address - Phone:252-717-5743
Mailing Address - Fax:
Practice Address - Street 1:696 N SPENCE AVE STE C
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4354
Practice Address - Country:US
Practice Address - Phone:919-581-7072
Practice Address - Fax:919-288-1879
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20208101YA0400X
NCC012197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)