Individual
DEWAYNE GENE JIMMIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 1ST AVE, SUITE 400, FAIRBANKS, AK 99701-4803
(907) 452-8251
Mailing address
122 1ST AVE, SUITE 400, FAIRBANKS, AK 99701-4803
(907) 452-8251
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/29/2011
Last updated
11/29/2011
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