Provider Demographics
NPI:1174910939
Name:WARREN-JACQUES, ELIJAH EVIN (LCDC-I)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:EVIN
Last Name:WARREN-JACQUES
Suffix:
Gender:M
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3342
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77383-3342
Mailing Address - Country:US
Mailing Address - Phone:832-690-0354
Mailing Address - Fax:
Practice Address - Street 1:16140 KUYKENDAHL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3338
Practice Address - Country:US
Practice Address - Phone:713-636-2964
Practice Address - Fax:713-636-9686
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)