Healthcare Provider Details

I. General information

NPI: 1407040603
Provider Name (Legal Business Name): ERIC DARNELL DEVERS MHRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 15TH ST #22
RICHMOND CA
94801-3273
US

IV. Provider business mailing address

2523 EL PORTAL DR #103
SAN PABLO CA
94806-3305
US

V. Phone/Fax

Practice location:
  • Phone: 510-776-0360
  • Fax:
Mailing address:
  • Phone: 510-374-7500
  • Fax: 510-374-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: