Healthcare Provider Details

I. General information

NPI: 1285553016
Provider Name (Legal Business Name): EMMA GRACE BUTCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 OHEAR AVE STE 100
NORTH CHARLESTON SC
29405-5091
US

IV. Provider business mailing address

9209 EVADO LN
SUMMERVILLE SC
29486-7140
US

V. Phone/Fax

Practice location:
  • Phone: 843-934-7575
  • Fax: 843-543-6340
Mailing address:
  • Phone: 843-513-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: