Provider Demographics
NPI:1407325459
Name:DEWS, DERRICK SR (QMHP-C)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:DEWS
Suffix:SR
Gender:M
Credentials:QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 OMNI PL
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1133
Mailing Address - Country:US
Mailing Address - Phone:434-229-7971
Mailing Address - Fax:
Practice Address - Street 1:203 OMNI PL
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-1133
Practice Address - Country:US
Practice Address - Phone:434-229-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health