Provider Demographics
NPI:1558047753
Name:BUTLER, JORDAN ALEXANDRA (LAPC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEXANDRA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1922
Mailing Address - Country:US
Mailing Address - Phone:470-686-4499
Mailing Address - Fax:
Practice Address - Street 1:25 E BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1922
Practice Address - Country:US
Practice Address - Phone:470-686-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008927101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor