Provider Demographics
NPI:1427769215
Name:JAYCAR WELLNESS GROUP LLC
Entity type:Organization
Organization Name:JAYCAR WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEARALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:LMSW, LISW
Authorized Official - Phone:734-757-0308
Mailing Address - Street 1:47 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-7430
Mailing Address - Country:US
Mailing Address - Phone:734-757-0308
Mailing Address - Fax:
Practice Address - Street 1:47 CARRIAGE WAY
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-7430
Practice Address - Country:US
Practice Address - Phone:734-757-0308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty