Healthcare Provider Details

I. General information

NPI: 1225792807
Provider Name (Legal Business Name): MEGHAN CATHERINE BUTLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 06/26/2022
Certification Date: 06/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 MIDWAY RD BLDG 1618
VIRGINIA BEACH VA
23459-9305
US

IV. Provider business mailing address

9611 NANSEMOND BAY ST APT 205
NORFOLK VA
23518-6022
US

V. Phone/Fax

Practice location:
  • Phone: 757-613-3277
  • Fax:
Mailing address:
  • Phone: 313-303-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY10233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: