Individual
MR. REAL DELAVERGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
1300 BAY AREA BLVD # A, HOUSTON, TX 77058-2505
(281) 212-2918
Mailing address
3304 CEDARCREST DR, PASADENA, TX 77503-2122
(281) 212-2918
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
9214
TX
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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