Provider Demographics
NPI:1154521284
Name:BUTLER, KAY LH (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:LH
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 1:3151 STILLHOUSE CREEK DR SE UNIT 24523
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3554
Mailing Address - Country:US
Mailing Address - Phone:703-869-2433
Mailing Address - Fax:
Practice Address - Street 1:1300 JOSEPH E BOONE BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2032
Practice Address - Country:US
Practice Address - Phone:678-843-8791
Practice Address - Fax:404-753-6955
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA09040046661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPENDINGMedicare PIN