Provider Demographics
NPI:1316768286
Name:DOCKERY, JEREMY (CADC, SAP, ICAADC,)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:DOCKERY
Suffix:
Gender:M
Credentials:CADC, SAP, ICAADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 NEUDORF RD # 10
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8993
Mailing Address - Country:US
Mailing Address - Phone:336-725-5129
Mailing Address - Fax:336-245-1174
Practice Address - Street 1:2511 NEUDORF RD STE D
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8922
Practice Address - Country:US
Practice Address - Phone:336-725-5129
Practice Address - Fax:336-245-1174
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23223101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)