Provider Demographics
NPI:1811104383
Name:BUTCHER, JIMMIE J (PHD)
Entity type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:J
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NDU HEALTH AND FITNESS 300 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20319-0001
Mailing Address - Country:US
Mailing Address - Phone:202-685-0729
Mailing Address - Fax:
Practice Address - Street 1:NDU HEALTH AND FITNESS 300 5TH AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20319-0001
Practice Address - Country:US
Practice Address - Phone:202-685-0729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical