Provider Demographics
NPI:1487263893
Name:BUTLER, JORDAN (LCPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 MADISON ST APT 404
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-6432
Mailing Address - Country:US
Mailing Address - Phone:443-244-1963
Mailing Address - Fax:
Practice Address - Street 1:GEORGE WASHINGTON UNIVERSITY CHARLES SMITH CENTER
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20052-0001
Practice Address - Country:US
Practice Address - Phone:202-994-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC200001972101YM0800X
MDLC11127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health