Provider Demographics
NPI:1457173106
Name:DRAKE, EUGENE MARKELL
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:MARKELL
Last Name:DRAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:EUGENE
Other - Middle Name:
Other - Last Name:CONVERSE-DRAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2395 STANDARD AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:510-692-6415
Mailing Address - Fax:
Practice Address - Street 1:1111 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANSISCO
Practice Address - State:CA
Practice Address - Zip Code:94103
Practice Address - Country:US
Practice Address - Phone:415-573-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19541101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)