Healthcare Provider Details

I. General information

NPI: 1215760517
Provider Name (Legal Business Name): VIRGINIA ELIZABETH BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 EAST BLVD
CHARLOTTE NC
28203-5114
US

IV. Provider business mailing address

760 GLENWOOD DR
ATHENS GA
30606-4628
US

V. Phone/Fax

Practice location:
  • Phone: 919-375-0475
  • Fax:
Mailing address:
  • Phone: 706-424-4632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73926
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: