Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813000572 | VA |
NPI | 1093223521 |
---|---|
Provider Name | Mr. Jeffrey Darrell Butler |
First Address | King George, VA 22485-3469 |
Second Address | King George, VA 22485-3469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2018 |
Last Update Date | 18/01/2018 |