Provider Demographics
NPI:1164246609
Name:BUTLER, BARONESS B (LCSW)
Entity type:Individual
Prefix:MS
First Name:BARONESS
Middle Name:B
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 1:1200 HARRISON CREEK BLVD APT 5105
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4788
Mailing Address - Country:US
Mailing Address - Phone:404-313-5104
Mailing Address - Fax:
Practice Address - Street 1:1200 HARRISON CREEK BLVD APT 5105
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4788
Practice Address - Country:US
Practice Address - Phone:404-313-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040170331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical