Provider Demographics
NPI:1134890296
Name:BUTLER, ELIZABETH (RADT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5049
Mailing Address - Country:US
Mailing Address - Phone:707-644-2577
Mailing Address - Fax:707-644-5501
Practice Address - Street 1:1969 GRANDE CIR APT 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4212
Practice Address - Country:US
Practice Address - Phone:707-720-6090
Practice Address - Fax:707-644-5501
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1367191019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)