Provider Demographics
NPI:1750963005
Name:DANGERFIELD, JOVON DUPREE (SUD COUNSELOR)
Entity type:Individual
Prefix:
First Name:JOVON
Middle Name:DUPREE
Last Name:DANGERFIELD
Suffix:
Gender:M
Credentials:SUD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CANDY ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2034
Mailing Address - Country:US
Mailing Address - Phone:661-717-1093
Mailing Address - Fax:
Practice Address - Street 1:1010 1/2 UNION AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-3642
Practice Address - Country:US
Practice Address - Phone:661-321-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1423860421101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)