Provider Demographics
NPI:1992919039
Name:BUTLER, GEANNA N (MED LCPC)
Entity type:Individual
Prefix:
First Name:GEANNA
Middle Name:N
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MED LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10203 SNOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708
Mailing Address - Country:US
Mailing Address - Phone:301-953-1397
Mailing Address - Fax:
Practice Address - Street 1:3060 MITCHELLVILLE RD
Practice Address - Street 2:# 212
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-218-5492
Practice Address - Fax:301-218-9514
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional