Provider Demographics
NPI:1114112638
Name:BRICKER, JEREMY BARRETT
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:BARRETT
Last Name:BRICKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 REGENT PARK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3727
Mailing Address - Country:US
Mailing Address - Phone:828-505-1762
Mailing Address - Fax:
Practice Address - Street 1:18 REGENT PARK BLVD STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3727
Practice Address - Country:US
Practice Address - Phone:828-505-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410049Medicaid