Provider Demographics
NPI:1467039909
Name:NERUD, JAN ERIC (CADC-I)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:ERIC
Last Name:NERUD
Suffix:
Gender:M
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 RIVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8300
Mailing Address - Country:US
Mailing Address - Phone:404-907-7184
Mailing Address - Fax:
Practice Address - Street 1:1421 BLUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4809
Practice Address - Country:US
Practice Address - Phone:803-733-5855
Practice Address - Fax:803-733-5892
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1469101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)