Provider Demographics
NPI:1023879905
Name:BUTLER, SHALICIA MONAYE
Entity type:Individual
Prefix:
First Name:SHALICIA
Middle Name:MONAYE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11861 COURSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4404
Mailing Address - Country:US
Mailing Address - Phone:225-612-8656
Mailing Address - Fax:225-250-1430
Practice Address - Street 1:11861 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4404
Practice Address - Country:US
Practice Address - Phone:225-612-8656
Practice Address - Fax:225-250-1430
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)