Provider Demographics
NPI:1477868636
Name:BUTKOWSKI, JOHN (CSAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BUTKOWSKI
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:SIMPSON
Mailing Address - State:NC
Mailing Address - Zip Code:27879-0220
Mailing Address - Country:US
Mailing Address - Phone:252-822-1065
Mailing Address - Fax:
Practice Address - Street 1:1310 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5931
Practice Address - Country:US
Practice Address - Phone:252-321-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)