Healthcare Provider Details

I. General information

NPI: 1952599466
Provider Name (Legal Business Name): BRENDA MARVET BUTLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 EAST CLEMMONSVILLE RD
WINSTON-SALEM NC
27107-2710
US

IV. Provider business mailing address

441 E CLEMMONSVILLE RD
WINSTON SALEM NC
27107-5202
US

V. Phone/Fax

Practice location:
  • Phone: 336-986-2544
  • Fax: 336-725-8638
Mailing address:
  • Phone: 336-986-2544
  • Fax: 336-725-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberHC4288
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberHC4288
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC4288
License Number StateNC

VIII. Authorized Official

Name: MS. BRENDA BUTLER
Title or Position: OWNER
Credential:
Phone: 336-986-2544