Individual
MR. BROCK DEVERE CARTER JENIKOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-II, ICADC
Contact information
Practice address
44359 PALM ST, INDIO, CA 92201-3116
(760) 342-6616
(760) 347-8276
Mailing address
51165 EISENHOWER DR APT B, LA QUINTA, CA 92253-3084
(760) 883-7441
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A051980920
CA
Other
Enumeration date
04/30/2024
Last updated
04/30/2024
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