Provider Demographics
NPI:1790934628
Name:BUTTERFLIES AND BUMBLEBEES 1, LLC
Entity Type:Organization
Organization Name:BUTTERFLIES AND BUMBLEBEES 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:WALTON
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, CBT
Authorized Official - Phone:336-655-2036
Mailing Address - Street 1:500 W NORTHWEST BLVD # 106
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-6526
Mailing Address - Country:US
Mailing Address - Phone:336-655-2036
Mailing Address - Fax:
Practice Address - Street 1:500 W NORTHWEST BLVD # 106
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-6526
Practice Address - Country:US
Practice Address - Phone:336-655-2036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102683Medicaid