Provider Demographics
NPI:1437515822
Name:BUTLER, SUSAN LYN (MED, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LEE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3315
Mailing Address - Country:US
Mailing Address - Phone:770-838-4357
Mailing Address - Fax:770-832-6421
Practice Address - Street 1:122 LEE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3315
Practice Address - Country:US
Practice Address - Phone:770-838-4357
Practice Address - Fax:770-832-6421
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional