Provider Demographics
NPI:1881234391
Name:MEADORS, JASON EDWARD SR (RADT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:EDWARD
Last Name:MEADORS
Suffix:SR
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 PECAN PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1911
Mailing Address - Country:US
Mailing Address - Phone:925-812-1489
Mailing Address - Fax:
Practice Address - Street 1:1408 A ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2331
Practice Address - Country:US
Practice Address - Phone:925-978-2873
Practice Address - Fax:925-757-0411
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty