Provider Demographics
NPI:1326472101
Name:MORCH, DEREK ANTON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:ANTON
Last Name:MORCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1113
Mailing Address - Country:US
Mailing Address - Phone:571-265-5355
Mailing Address - Fax:
Practice Address - Street 1:709 PENDLETON ST
Practice Address - Street 2:STE 201
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1820
Practice Address - Country:US
Practice Address - Phone:703-755-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA09040086091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health