MEDICARE: MRS. LISA BUTLER CREEF L.C.S.W., P.C.

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	1041C0700X	Clinical Social Worker	C006138	NC
2	1041C0700X	Clinical Social Worker	0904001497	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598788747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA BUTLER CREEF L.C.S.W., P.C.

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	SOUTH MILLS
State	:	NC
Zip	:	27976-0188
Country	:	US
Telephone Number	:	252-335-5346
Fax Number	:	252-335-5365

Provider Business Practice Location Address
First Line	:	1241 B. NORTH ROAD ST.
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3335
Country	:	US
Telephone Number	:	252-335-5346
Fax Number	:	252-335-5365

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/13/2009

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