Healthcare Provider Details

I. General information

NPI: 1588140859
Provider Name (Legal Business Name): BUTTERFLY DEVELOPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 GRAYSON HIGHWAY SUITE 8-242
GRAYSON GA
30017
US

IV. Provider business mailing address

1803 OVER LAKE DR SE STE B
CONYERS GA
30013-1789
US

V. Phone/Fax

Practice location:
  • Phone: 678-973-7358
  • Fax:
Mailing address:
  • Phone: 678-973-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. TRACY DWYER
Title or Position: OWNER
Credential: MSW
Phone: 678-973-7358