Provider Demographics
NPI:1518578723
Name:BUTLER, DUSTIN SHANE
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:SHANE
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1542
Mailing Address - Country:US
Mailing Address - Phone:540-965-6468
Mailing Address - Fax:540-965-9268
Practice Address - Street 1:273 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1542
Practice Address - Country:US
Practice Address - Phone:540-965-6468
Practice Address - Fax:540-965-9268
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health