MEDICARE: BRENDA MARVET BUTLER

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	3747P1801X	Personal Care Attendant	HC4288	NC
2	251S00000X	Community/Behavioral Health Agency
3	374U00000X	Home Health Aide
4	101YM0800X	Mental Health Counselor		NC
5	3747A0650X	Attendant Care Provider	HC4288	NC
6	101YA0400X	Addiction (Substance Use Disorder) Counselor		NC
7	343900000X	Non-emergency Medical Transport (VAN)
8	372600000X	Adult Companion	HC4288	NC
9	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1952599466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENDA MARVET BUTLER

Provider Business Mailing Address
First Line	:	1427 S MARTIN LUTHER KING JR DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-1306
Country	:	US
Telephone Number	:	336-986-2544
Fax Number	:	336-725-8638

Provider Business Practice Location Address
First Line	:	1427 S MARTIN LUTHER KING JR DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-1306
Country	:	US
Telephone Number	:	336-986-2544
Fax Number	:	336-725-8638

Authorized Official
Title or Position	:	OWNER
Name	:	MS. BRENDA BUTLER
Credential	:
Telephone Number	:	336-986-2544

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	05/19/2026

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