Provider Demographics
NPI:1952425480
Name:AYRES, JEFFREY RICHARD (CAC1)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RICHARD
Last Name:AYRES
Suffix:
Gender:M
Credentials:CAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SALMER AVE
Mailing Address - Street 2:#23
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2065
Mailing Address - Country:US
Mailing Address - Phone:248-320-9466
Mailing Address - Fax:248-738-8404
Practice Address - Street 1:3139 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3636
Practice Address - Country:US
Practice Address - Phone:248-320-9466
Practice Address - Fax:248-738-8404
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)