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General NPI Number Information
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NPI Number | 1861728602
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Entity Type | Individual
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Provider Name | JERE CLIFTON BREWER CADAC-II
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Gender | Male
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 4301 W MARKHAM ST # 835
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-526-8422
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Fax | 501-526-8499
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Provider Business Mailing Address
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Address Line | 9601 REDWOOD BLVD
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City | CALIFORNIA CITY
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State | CA
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Zip | 93505-3675
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Country | US
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Telephone | 850-499-7838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | RA858109
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 119945
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1559
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License Number State | AR
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