Provider Demographics
NPI:1689863177
Name:VERMILLION, JARRED CLARK
Entity Type:Individual
Prefix:MR
First Name:JARRED
Middle Name:CLARK
Last Name:VERMILLION
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 1:3421 ROWE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6933
Mailing Address - Country:US
Mailing Address - Phone:619-792-9180
Mailing Address - Fax:619-281-3714
Practice Address - Street 1:6160 MISSION GORGE RD
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3410
Practice Address - Country:US
Practice Address - Phone:619-281-3706
Practice Address - Fax:619-281-3714
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health