MEDICARE: MRS. HEATHER LOUISE BUTLER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701008764	VA

General Provider Information

NPI Number	:	1396381620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER LOUISE BUTLER LPC

Provider Business Mailing Address
First Line	:	258 N WITCHDUCK RD STE 1B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6556
Country	:	US
Telephone Number	:	757-385-0914
Fax Number	:	757-961-0184

Provider Business Practice Location Address
First Line	:	258 N WITCHDUCK RD STE 1B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6556
Country	:	US
Telephone Number	:	757-385-0914
Fax Number	:	757-961-0184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/21/2019

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