Provider Demographics
NPI:1053921395
Name:BUTLER, RACHELLE LEE (LCSW)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 E BROAD ST APT A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7342
Mailing Address - Country:US
Mailing Address - Phone:804-569-5497
Mailing Address - Fax:
Practice Address - Street 1:2820 E BROAD ST APT A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7342
Practice Address - Country:US
Practice Address - Phone:804-569-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040103041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical