Provider Demographics
NPI:1215347687
Name:BUTALA, CHASE C (CRC, LPC)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:C
Last Name:BUTALA
Suffix:
Gender:M
Credentials:CRC, LPC
Other - Prefix:MR
Other - First Name:CHASE
Other - Middle Name:CHRISTOPHER
Other - Last Name:BUTALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CRC, LPC
Mailing Address - Street 1:7051 HEATHCOTE VILLAGE WAY STE 115
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3197
Mailing Address - Country:US
Mailing Address - Phone:804-207-6737
Mailing Address - Fax:
Practice Address - Street 1:7051 HEATHCOTE VILLAGE WAY STE 115
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3197
Practice Address - Country:US
Practice Address - Phone:804-207-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
VA0701006265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor