Individual
DAVID PAUL JETER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
4506 BRADSHAW ST, DALLAS, TX 75215-4429
(214) 280-4496
Mailing address
4506 BRADSHAW ST, DALLAS, TX 75215-4429
(214) 280-4496
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5700
TX
Other
Enumeration date
03/16/2018
Last updated
06/16/2018
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