Provider Demographics
NPI:1629778972
Name:HERRON, DERRECK
Entity Type:Individual
Prefix:
First Name:DERRECK
Middle Name:
Last Name:HERRON
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 1:16926 PORTERS INN DR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2575
Mailing Address - Country:US
Mailing Address - Phone:703-883-7245
Mailing Address - Fax:
Practice Address - Street 1:UMBRELLA THERAPEUTIC SERVICES
Practice Address - Street 2:3300 PENNSYLVANIA AVE, SE
Practice Address - City:WASHINGTON D. C.
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-878-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker