Provider Demographics
NPI:1992053912
Name:BUTLER, CATHERINE B
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:B
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CHARTER BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4854
Mailing Address - Country:US
Mailing Address - Phone:478-474-6584
Mailing Address - Fax:478-474-6585
Practice Address - Street 1:420 CHARTER BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4854
Practice Address - Country:US
Practice Address - Phone:478-474-6584
Practice Address - Fax:478-474-6585
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional