Provider Demographics
NPI:1588064398
Name:BUTLER, JUDY H (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:H
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 STUART DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7111
Mailing Address - Country:US
Mailing Address - Phone:336-269-0818
Mailing Address - Fax:
Practice Address - Street 1:301 S THIRD ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2617
Practice Address - Country:US
Practice Address - Phone:336-269-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral