Jeremy Dockery, CADC, SAP, ICAADC,

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

23223 Issued in NC

Practice address

2511 Neudorf Rd Ste D
Clemmons, NC 27012-8922

Phone

(336) 725-5129

Fax

(336) 245-1174

NPI assigned

Oct 22, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730592000000",
    "number": "1316768286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 NEUDORF RD # 10",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128993",
            "telephone_number": "336-725-5129",
            "fax_number": "336-245-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 NEUDORF RD STE D",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128922",
            "telephone_number": "336-725-5129",
            "fax_number": "336-245-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOCKERY",
        "first_name": "JEREMY",
        "name_prefix": "Mr.",
        "credential": "CADC, SAP, ICAADC,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-22",
        "last_updated": "2024-11-03",
        "certification_date": "2024-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "23223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lia Deland
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• Todd Michael Derreberry, M.D.
• Rebecca Dey, PHARMD
• Rhonda Wallace Dixon, WHNP
• Terry Ann Donovan, DPM
• Jodi M Douthit
• Dove Medical Supply Retail LLC
• Elisabeth Dowlen
• Brian William Downs, MD

• All providers in Clemmons, NC
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.