Provider Demographics
NPI:1407967664
Name:BUTLER, JEWEL RAYSHELLA (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEWEL
Middle Name:RAYSHELLA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:SUITE I
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6522
Mailing Address - Country:US
Mailing Address - Phone:919-455-5733
Mailing Address - Fax:
Practice Address - Street 1:853 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:SUITE I
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6522
Practice Address - Country:US
Practice Address - Phone:919-455-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5075101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8521Other5 COUNTY MENTAL HLTH AUTH
NC6103134Medicaid
NC14142OtherNC HEALTH CHOICE