Provider Demographics
NPI:1639663057
Name:BUTLER, BREANNA (LCMHC-S)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCMHC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 PROVIDENCE RD # RS1010
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2684
Mailing Address - Country:US
Mailing Address - Phone:980-254-3947
Mailing Address - Fax:980-246-3649
Practice Address - Street 1:9024 FISHERS POND DR
Practice Address - Street 2:B2
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:980-254-3947
Practice Address - Fax:980-246-3649
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health