MEDICARE: MRS. JACQUELINE DENISE BUTLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	090400640	VA
2	1041C0700X	Clinical Social Worker	0904006406	VA
3	101Y00000X	Counselor	0904006406	VA
4	101YM0800X	Mental Health Counselor	0904006406	VA
5	101YP1600X	Pastoral Counselor	0904006406	VA
6	101YS0200X	School Counselor	0904006406	VA
7	101YS0200X	School Counselor	PPS-0600412	VA
8	106H00000X	Marriage & Family Therapist	0904006406	VA
9	251B00000X	Case Management Agency	0904006406	VA
10	104100000X	Social Worker	0904006406	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386782993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE DENISE BUTLER LCSW

Provider Business Mailing Address
First Line	:	900 COMMONWEALTH PL STE 232
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4517
Country	:	US
Telephone Number	:	757-456-9205
Fax Number	:	757-456-9209

Provider Business Practice Location Address
First Line	:	900 COMMONWEALTH PL STE 232
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4517
Country	:	US
Telephone Number	:	757-456-9205
Fax Number	:	757-456-9209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	12/20/2024

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