Provider Demographics
NPI:1033847140
Name:PATTERSON, DEREK W (RCMHI)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:W
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:RCMHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 HOWLAND BLVD UNIT 390267
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32739-7513
Mailing Address - Country:US
Mailing Address - Phone:386-610-2040
Mailing Address - Fax:386-232-5002
Practice Address - Street 1:2808 ENTERPRISE RD STE 105
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2753
Practice Address - Country:US
Practice Address - Phone:386-610-2040
Practice Address - Fax:386-232-5002
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health