Provider Demographics
NPI:1407429962
Name:BUTLER, XAVIER CARLOS
Entity type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:CARLOS
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 GEORGIA AVE NW UNIT 3026
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-7501
Mailing Address - Country:US
Mailing Address - Phone:202-880-6167
Mailing Address - Fax:771-212-0485
Practice Address - Street 1:3321 GEORGIA AVE NW UNIT 3026
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-7501
Practice Address - Country:US
Practice Address - Phone:202-880-6167
Practice Address - Fax:771-212-0485
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 172A00000X
1-22-57970103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty