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General NPI Number Information
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NPI Number | 1629311394
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Entity Type | Individual
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Provider Name | TATAVIA BUTLER LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 7707 SOUTH AUSTIN RD
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City | STOCKTON
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State | CA
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Zip | 95215-8312
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Country | US
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Telephone | 818-570-6752
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Fax | 818-570-6752
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Provider Business Mailing Address
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Address Line | PO BOX 3245
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City | HAYWARD
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State | CA
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Zip | 94540-3245
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Country | US
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Telephone | 405-431-0833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 101952
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License Number State | CA
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