Provider Demographics
NPI:1467799114
Name:BUTLER, WILLIAM RUSSELL (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 SEABOARD ST
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28347-9724
Mailing Address - Country:US
Mailing Address - Phone:910-714-7814
Mailing Address - Fax:
Practice Address - Street 1:196 SEABOARD ST
Practice Address - Street 2:
Practice Address - City:HOFFMAN
Practice Address - State:NC
Practice Address - Zip Code:28347
Practice Address - Country:US
Practice Address - Phone:910-714-7814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCC01111291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)