Provider Demographics
NPI:1093223521
Name:BUTLER, JEFFREY DARRELL (MA/CAS, NCSP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DARRELL
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MA/CAS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 FOXES WAY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3469
Mailing Address - Country:US
Mailing Address - Phone:540-775-3535
Mailing Address - Fax:
Practice Address - Street 1:10100 FOXES WAY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3469
Practice Address - Country:US
Practice Address - Phone:540-775-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000572103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool