Provider Information for 1861570293
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Mr. MARK STANLEY BUTKUS LISW-CP
Sex: Male
NPI: 1861570293
Last Updated: 2016-05-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1861570293 | ||||||||
| Enumeration Date | 2006-11-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6542 BUCKFIELD DR COLUMBIA, SC 29206-1313 United States Phone: 803-369-3743 | Fax: | ||||||||
| Primary Practice Address | 3809 ROSEWOOD DR COLUMBIA, SC 29205-3533 United States Phone: 803-786-1844 | Fax:803-754-7783 | ||||||||
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