Active NPI
Jackie M Butler, CCS
- Addiction (Substance Use Disorder) Counselor
- High Point, NC
National Provider Identifier
1033237961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 153
- Practice address
- 5209 W Wendover Ave
High Point, NC 27265-9177 - Phone
- (336) 812-8645
- Fax
- (336) 812-8652
- NPI assigned
- Mar 27, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 153 | NC | Primary |
Addresses
Primary practice location
5209 W Wendover Ave
High Point, NC 27265-9177
Mailing address
1404 Heatherbrook Dr
High Point, NC 27265-9515
Phone (336) 880-0642
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6110523 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 153 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1033237961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1404 HEATHERBROOK DR",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272659515",
"telephone_number": "336-880-0642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5209 W WENDOVER AVE",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272659177",
"telephone_number": "336-812-8645",
"fax_number": "336-812-8652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTLER",
"first_name": "JACKIE",
"middle_name": "M",
"credential": "CCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "153",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6110523",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in High Point, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.