Provider Demographics
NPI:1003437450
Name:BUTCHER, ADRIANA J
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:J
Last Name:BUTCHER
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 1:2008 N LAWLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-3136
Mailing Address - Country:US
Mailing Address - Phone:708-860-1201
Mailing Address - Fax:708-221-6679
Practice Address - Street 1:2008 N LAWLER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3136
Practice Address - Country:US
Practice Address - Phone:708-860-1201
Practice Address - Fax:708-221-6679
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL178.012821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.012821OtherLICENSED PROFESSIONAL COUNSELOR