Healthcare Provider Details

I. General information

NPI: 1417541210
Provider Name (Legal Business Name): ARIANNA BACON BUTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S WASHINGTON ST STE 202
ALEXANDRIA VA
22314-5403
US

IV. Provider business mailing address

300 S WASHINGTON ST STE 202
ALEXANDRIA VA
22314-5403
US

V. Phone/Fax

Practice location:
  • Phone: 301-485-6226
  • Fax:
Mailing address:
  • Phone: 301-485-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121001234
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: