Provider Demographics
NPI:1144999392
Name:BUTTRILL, BRYCE OLIVIA (MA, LPC)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:OLIVIA
Last Name:BUTTRILL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:BRYCE
Other - Middle Name:OLIVIA
Other - Last Name:MAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 CARLISLE WAY
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4329
Mailing Address - Country:US
Mailing Address - Phone:175-733-5125
Mailing Address - Fax:
Practice Address - Street 1:1000 COMMERCIAL LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8148
Practice Address - Country:US
Practice Address - Phone:757-335-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010766101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health