Provider Demographics
NPI:1255786828
Name:HARE, ERIC ALLEN (CADC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ALLEN
Last Name:HARE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NORTH STEWART STREET
Mailing Address - Street 2:SUTIE 120
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89503
Mailing Address - Country:US
Mailing Address - Phone:775-350-7250
Mailing Address - Fax:775-461-3570
Practice Address - Street 1:1201 NORTH STEWART STREET
Practice Address - Street 2:SUTIE 120
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89503
Practice Address - Country:US
Practice Address - Phone:775-350-7250
Practice Address - Fax:775-461-3570
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV880402361101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)