Healthcare Provider Details

I. General information

NPI: 1639316847
Provider Name (Legal Business Name): MRS. CARNESSCA STYNCHULA BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 11/16/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2752 ERIE AVE STE 5
CINCINNATI OH
45208-2207
US

IV. Provider business mailing address

2752 ERIE AVE STE 5
CINCINNATI OH
45208-2207
US

V. Phone/Fax

Practice location:
  • Phone: 216-810-4910
  • Fax:
Mailing address:
  • Phone: 567-202-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1700399-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: