Provider Demographics
NPI:1366179178
Name:BUTLER, JENIFER RENEE (MA, MAML, LGPC)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:RENEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA, MAML, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 RUMSEY PL
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3830
Mailing Address - Country:US
Mailing Address - Phone:443-922-7979
Mailing Address - Fax:
Practice Address - Street 1:1301 CONTINENTAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2338
Practice Address - Country:US
Practice Address - Phone:667-600-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty