Healthcare Provider Details

I. General information

NPI: 1467799114
Provider Name (Legal Business Name): WILLIAM RUSSELL BUTLER LCSW, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 SEABOARD ST
HOFFMAN NC
28347
US

IV. Provider business mailing address

109 BUTLER DR
HOFFMAN NC
28347-9778
US

V. Phone/Fax

Practice location:
  • Phone: 910-714-7814
  • Fax:
Mailing address:
  • Phone: 910-557-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: