Provider Demographics
NPI:1790426674
Name:BUTLER, TREMAYNE J (LCAS,LMCHC-A, CCSI)
Entity Type:Individual
Prefix:
First Name:TREMAYNE
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LCAS,LMCHC-A, CCSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LADORA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6414
Mailing Address - Country:US
Mailing Address - Phone:954-439-5449
Mailing Address - Fax:
Practice Address - Street 1:1525 LADORA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6414
Practice Address - Country:US
Practice Address - Phone:954-439-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18771101YP2500X
NCLCAS-25738101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional