Provider Demographics
NPI:1326094418
Name:TIERNEY-BUTLER, ERIN (LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TIERNEY-BUTLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-0189
Mailing Address - Country:US
Mailing Address - Phone:804-556-5400
Mailing Address - Fax:804-556-5403
Practice Address - Street 1:3910 OLD BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5719
Practice Address - Country:US
Practice Address - Phone:804-556-5400
Practice Address - Fax:804-556-5403
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA159800OtherANTHEM - POWH LOC
VAA932447OtherVALUE OPTIONS
VA159813OtherANTHEM - GCH LOC
VA159813OtherHEALTHKEEPERS - GCH LOC
VA2128469OtherMAMSI
VAO81629MOtherSENTARA
VA159800OtherHEALTHKEEPERS - PWH LOC