Provider Demographics
NPI:1841431814
Name:DERWIN, TIMOTHY J (BS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:DERWIN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1329
Mailing Address - Country:US
Mailing Address - Phone:906-387-4721
Mailing Address - Fax:906-387-4727
Practice Address - Street 1:622 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1329
Practice Address - Country:US
Practice Address - Phone:906-387-4721
Practice Address - Fax:906-387-4727
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)