Provider Demographics
NPI:1598731853
Name:BUTT, ASHLEY REY (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REY
Last Name:BUTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:BUTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:357 SHARITZ RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4670
Mailing Address - Country:US
Mailing Address - Phone:276-613-9208
Mailing Address - Fax:
Practice Address - Street 1:770 W RIDGE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1187
Practice Address - Country:US
Practice Address - Phone:276-223-3202
Practice Address - Fax:276-546-8733
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040057001041C0700X
NCC0058651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598731853Medicaid