Provider Demographics
NPI:1801515838
Name:BUTLER, LAKEESA SHAWNTIA (LCSWA)
Entity type:Individual
Prefix:
First Name:LAKEESA
Middle Name:SHAWNTIA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 WESTERN BLVD APT 3F
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6885
Mailing Address - Country:US
Mailing Address - Phone:334-430-2232
Mailing Address - Fax:
Practice Address - Street 1:5055 WESTERN BLVD APT 3F
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6885
Practice Address - Country:US
Practice Address - Phone:334-430-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical