MEDICARE: QUZETTE PAULA BUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A16552	NC

General Provider Information

NPI Number	:	1083430599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUZETTE PAULA BUTLER

Provider Business Mailing Address
First Line	:	1109 CROSS LINK RD STE B #1022
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-4842
Country	:	US
Telephone Number	:	919-410-7871
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 CROSS LINK RD STE B
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-4842
Country	:	US
Telephone Number	:	919-410-7871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2024
Last Update Date	:	11/29/2024

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