MEDICARE: BIANCA 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
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1568203453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA BUTLER

Provider Business Mailing Address
First Line	:	2068 SITSER LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-6927
Country	:	US
Telephone Number	:	404-668-8035
Fax Number	:

Provider Business Practice Location Address
First Line	:	2068 SITSER LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-6927
Country	:	US
Telephone Number	:	470-562-9775
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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Directions to “ BIANCA BUTLER ” Practice Location

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