Individual
JACKIE M BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCS
Contact information
Practice address
5209 W WENDOVER AVE, HIGH POINT, NC 27265-9177
(336) 812-8645
(336) 812-8652
Mailing address
1404 HEATHERBROOK DR, HIGH POINT, NC 27265-9515
(336) 880-0642
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
153
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6110523
—
NC
Enumeration date
03/27/2007
Last updated
07/09/2007
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