Basic Information
| Provider Information | |||||||||
| NPI: | 1215347687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTALA | ||||||||
| FirstName: | CHASE | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS CRC LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 WATERCOURSE DR | ||||||||
| Address2: | |||||||||
| City: | RANSON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042708179 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ATLANTIC COUNSELING GROUP | ||||||||
| Address2: | 22363 GLEN DR STE 105 | ||||||||
| City: | STARLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201644442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036217121 | ||||||||
| FaxNumber: | 7036657686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701006265 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 225C00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.