Provider Demographics
NPI:1841597317
Name:BUTLER, THERESA MARIE (LPC, CAADC, NCC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPC, CAADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 PHILLIPS ST STE A
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2242
Mailing Address - Country:US
Mailing Address - Phone:570-517-0892
Mailing Address - Fax:570-476-6466
Practice Address - Street 1:724 PHILLIPS ST STE A
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2242
Practice Address - Country:US
Practice Address - Phone:570-517-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC006889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health