Provider Demographics
NPI:1194078519
Name:BUTLER, PATINA VENICE (MFTI, PCCI)
Entity type:Individual
Prefix:MS
First Name:PATINA
Middle Name:VENICE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MFTI, PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1506
Mailing Address - Country:US
Mailing Address - Phone:510-437-8950
Mailing Address - Fax:
Practice Address - Street 1:2648 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1506
Practice Address - Country:US
Practice Address - Phone:510-437-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program