Provider Demographics
NPI:1063189850
Name:EMERY, DUSTIN JAMES WALKER
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES WALKER
Last Name:EMERY
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 1:2781 W RAMSEY ST STE 3&4
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3700
Mailing Address - Country:US
Mailing Address - Phone:951-417-6612
Mailing Address - Fax:
Practice Address - Street 1:2781 W RAMSEY ST STE 3&4
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3700
Practice Address - Country:US
Practice Address - Phone:951-417-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician