Provider Demographics
NPI:1255868204
Name:SLEDGE, DERRICK (MS, MABS, LCDC, LPC)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:SLEDGE
Suffix:
Gender:M
Credentials:MS, MABS, LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W PLANO PKWY STE 2300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8612
Mailing Address - Country:US
Mailing Address - Phone:972-422-8383
Mailing Address - Fax:
Practice Address - Street 1:2001 W PLANO PKWY STE 2300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8612
Practice Address - Country:US
Practice Address - Phone:972-422-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX64040OtherLICENSED PROFESSIONAL COUNSELOR