Healthcare Provider Details

I. General information

NPI: 1255743423
Provider Name (Legal Business Name): JESSICA BUTLER CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 10/17/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W MARKET ST STE 105
GEORGETOWN DE
19947
US

IV. Provider business mailing address

501 W MARKET ST SUITE 105
GEORGETOWN DE
19947-1457
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax: 866-460-2997
Mailing address:
  • Phone: 302-778-9222
  • Fax: 302-403-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1944
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberQ4-0010230
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: