Provider Demographics
NPI:1619316700
Name:BATTLE, DEREK KENDALL (LCASA)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:KENDALL
Last Name:BATTLE
Suffix:
Gender:M
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 SURREYHILL CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1101
Mailing Address - Country:US
Mailing Address - Phone:443-996-8065
Mailing Address - Fax:
Practice Address - Street 1:3117 SURREYHILL CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1101
Practice Address - Country:US
Practice Address - Phone:443-996-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)