Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701006265 | VA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1215347687 |
---|---|
Provider Name | Mr. Chase Christopher Butala |
First Address | Ranson, WV 25438 |
Second Address | Starling, VA 20164-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 14/10/2020 |