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1730936642
BROCK DEVERE CARTER JENIKOVSKY
INDIO, CA
NPI
1730936642
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA A051980920)
Enumeration Date
2024-04-30
Last Update Date
2024-04-30
Business Address
Mr. BROCK DEVERE CARTER JENIKOVSKY CADC-II, ICADC
44359 PALM ST
INDIO, CA 92201-3116
Phone number: 760-342-6616
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Mailing Address
Mr. BROCK DEVERE CARTER JENIKOVSKY CADC-II, ICADC
51165 EISENHOWER DR APT B
LA QUINTA, CA 92253-3084
Phone number: 760-883-7441
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