Provider Demographics
NPI:1407638679
Name:BUTLER, CAROL (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PINEHURST RD UNIT 116
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94516-9800
Mailing Address - Country:US
Mailing Address - Phone:510-621-7011
Mailing Address - Fax:
Practice Address - Street 1:99 PINEHURST RD UNIT 116
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:CA
Practice Address - Zip Code:94516-9800
Practice Address - Country:US
Practice Address - Phone:510-621-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical