Provider Demographics
NPI:1831448620
Name:BUTLER, JADE EVA REYNOLDS (MS)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:EVA REYNOLDS
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 NASH ST W
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3058
Mailing Address - Country:US
Mailing Address - Phone:252-902-7799
Mailing Address - Fax:252-260-5727
Practice Address - Street 1:703 NASH ST W
Practice Address - Street 2:SUITE D
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3058
Practice Address - Country:US
Practice Address - Phone:252-902-7799
Practice Address - Fax:252-260-5727
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1685101YP2500X
NCA8767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional