Provider Demographics
NPI:1205896925
Name:BUTLER, VANESSA S (LCSW)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:S
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 E SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:704-867-2134
Practice Address - Street 1:420 N SALISBURY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3548
Practice Address - Country:US
Practice Address - Phone:336-243-7475
Practice Address - Fax:336-249-6771
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1387WOtherBCBS OF NC
NCE2495OtherMEDCOST
NC1043337OtherCIGNA BEHAVIORAL HEALTH
NC6003597Medicaid
NC1387WOtherBCBS OF NC