Provider Demographics
NPI:1437928025
Name:WILLIAMS, DERRICK BERNARD
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:BERNARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N HAMPTON RD # 450
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2391
Mailing Address - Country:US
Mailing Address - Phone:214-557-1072
Mailing Address - Fax:
Practice Address - Street 1:1801 N HAMPTON RD # 450
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2391
Practice Address - Country:US
Practice Address - Phone:214-557-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health