Healthcare Provider Details

I. General information

NPI: 1043888209
Provider Name (Legal Business Name): JESSIE LYNNE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RAVENSCROFT DR STE 102
ASHEVILLE NC
28801-3683
US

IV. Provider business mailing address

5 RAVENSCROFT DR STE 102
ASHEVILLE NC
28801-3683
US

V. Phone/Fax

Practice location:
  • Phone: 828-827-7239
  • Fax:
Mailing address:
  • Phone: 828-827-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27765
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17059
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: