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General NPI Number Information
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NPI Number | 1952599466
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Entity Type | Organization
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Legal Business Name | BRENDA MARVET BUTLER
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 441 EAST CLEMMONSVILLE RD
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City | WINSTON-SALEM
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State | NC
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Zip | 27107-2710
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Country | US
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Telephone | 336-986-2544
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Fax | 336-725-8638
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Provider Business Mailing Address
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Address Line | 441 E CLEMMONSVILLE RD
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City | WINSTON SALEM
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State | NC
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Zip | 27107-5202
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Country | US
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Telephone | 336-986-2544
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Fax | 336-725-8638
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Authorized Official
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Title or Position | OWNER
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Name | MS. BRENDA BUTLER
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Credential |
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Telephone | 336-986-2544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | HC4288
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | NC
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Taxonomy #7
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | HC4288
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License Number State | NC
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Taxonomy #8
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | HC4288
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License Number State | NC
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