NPI Profile for BRENDA BEVERLY in JACKSON, MI.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Addiction (Substance Use Disorder) |
101YA0400X |
| NPI # | 1043608680 |
|
| Status | Active | |
| Credentials | CADC | |
| Entity | Individual | |
| Enumeration date | 01/06/2015 | |
| Last updated | 01/06/2015 - About 11 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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BRENDA BEVERLY
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