Healthcare Provider Details

I. General information

NPI: 1841597317
Provider Name (Legal Business Name): THERESA BUTLER LPC, CAADC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1A BROOKFIELD GLEN DR
BELVIDERE NJ
07823-2854
US

IV. Provider business mailing address

64 WAVERLY DR APT A
STROUDSBURG PA
18360-1442
US

V. Phone/Fax

Practice location:
  • Phone: 908-652-5311
  • Fax:
Mailing address:
  • Phone: 570-460-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC006889
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: