Provider Demographics
NPI:1982172789
Name:BUTLER, CARLA KNOLL (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:KNOLL
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 OFFICE SQUARE LN STE B101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3652
Mailing Address - Country:US
Mailing Address - Phone:757-403-0119
Mailing Address - Fax:
Practice Address - Street 1:317 OFFICE SQUARE LN STE B101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3652
Practice Address - Country:US
Practice Address - Phone:757-403-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904010620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health