Provider Demographics
NPI:1669205506
Name:AYERS, DARIEN J
Entity type:Individual
Prefix:
First Name:DARIEN
Middle Name:J
Last Name:AYERS
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 1:5480 N HIGHWAY 99 BLDG C
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-1106
Mailing Address - Country:US
Mailing Address - Phone:510-650-7141
Mailing Address - Fax:
Practice Address - Street 1:5480 N HIGHWAY 99 BLDG C
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-1106
Practice Address - Country:US
Practice Address - Phone:510-650-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician