MEDICARE: BUTTERFLIES AND BUMBLEBEES 1, LLC

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	101YM0800X	Mental Health Counselor	2846	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790934628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTERFLIES AND BUMBLEBEES 1, LLC

Provider Business Mailing Address
First Line	:	500 W NORTHWEST BLVD # 106
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-6526
Country	:	US
Telephone Number	:	336-655-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W NORTHWEST BLVD # 106
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-6526
Country	:	US
Telephone Number	:	336-655-2036
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. DOROTHY WALTON WALKER
Credential	:	LPC, NCC, CBT
Telephone Number	:	336-655-2036

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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