Provider Demographics
NPI:1417144312
Name:BUTLER, ANDREA LEONA (MA, LCPC, LPC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LEONA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 TRIBUTARY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-6514
Mailing Address - Country:US
Mailing Address - Phone:443-826-9617
Mailing Address - Fax:
Practice Address - Street 1:6610 TRIBUTARY ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6514
Practice Address - Country:US
Practice Address - Phone:443-826-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GALPC010075101YP2500X
MDLC4928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD332704300Medicaid