Provider Demographics
NPI:1063189744
Name:BUTTS, TANEKA
Entity type:Individual
Prefix:
First Name:TANEKA
Middle Name:
Last Name:BUTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-3918
Mailing Address - Country:US
Mailing Address - Phone:443-365-8302
Mailing Address - Fax:
Practice Address - Street 1:560 RIVERSIDE DR STE B101
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4701
Practice Address - Country:US
Practice Address - Phone:443-365-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling