Basic Information
| Provider Information | |||||||||
| NPI: | 1386749026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 S GREEN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284373000 | ||||||||
| FaxNumber: | 2824374999 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 S GREEN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284373000 | ||||||||
| FaxNumber: | 2824374999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 01/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 3056 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6000683 | 05 | NC | MEDICAID |