Provider Demographics
NPI:1255536470
Name:JIMERSON, EUGENE (COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:JIMERSON
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4008
Mailing Address - Country:US
Mailing Address - Phone:415-922-2376
Mailing Address - Fax:
Practice Address - Street 1:1249 SCOTT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4008
Practice Address - Country:US
Practice Address - Phone:415-922-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA61852OtherAC BHCS CLINICIAN#