Healthcare Provider Details

I. General information

NPI: 1174603690
Provider Name (Legal Business Name): ANGELA MARETT BUTLER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA CHRISTINE MARETT PHD

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S LOUDOUN ST
WINCHESTER VA
22601
US

IV. Provider business mailing address

1509 STONE HOUSE CT
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-5431
  • Fax: 540-667-2655
Mailing address:
  • Phone: 540-542-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003713
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: