Individual
ELLIS RAY BUTLER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS-A
Contact information
Practice address
536 SIGNAL HILL DRIVE EXT, STATESVILLE, NC 28625-4391
(704) 872-0234
Mailing address
521 MONTGROVE PL NW, CONCORD, NC 28027-6554
(980) 319-4357
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS20060
NC
Other
Enumeration date
08/18/2017
Last updated
08/18/2017
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