MS. EBONY NICOLE DERRICKSON MS DDP NPI 1881336907

NPI Information

NPI: 1881336907
Provider Name: MS. EBONY NICOLE DERRICKSON, MS DDP
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
125 LEE BYRD RD
LOGANVILLE, GA
ZIP 30052
Phone: (678) 883-8609
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MS. Ebony Nicole Derrickson, MS DDP is a mental health counselor in Loganville, GA. MS. Ebony Nicole Derrickson, MS DDP NPI is 1881336907. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

125 LEE BYRD RD
LOGANVILLE, GA
ZIP 30052-310
Phone: (678) 883-8609

The enumeration date for this NPI number is 4/9/2022 and was last updated on 4/9/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	101Y00000X	Counselor			No
2	103TC1900X	Psychologist	Counseling		No
3	101YM0800X	Counselor	Mental Health	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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