Provider Demographics
NPI:1407040603
Name:DEVERS, ERIC DARNELL (MHRS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DARNELL
Last Name:DEVERS
Suffix:
Gender:M
Credentials:MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 EL PORTAL DR
Mailing Address - Street 2:#103
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3305
Mailing Address - Country:US
Mailing Address - Phone:510-374-7500
Mailing Address - Fax:510-374-7504
Practice Address - Street 1:248 15TH ST
Practice Address - Street 2:#22
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3273
Practice Address - Country:US
Practice Address - Phone:510-776-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1Medicaid