Provider Demographics
NPI:1851636021
Name:WHITE, DERRICK PHILLIP (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:PHILLIP
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 EUCLID AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3612
Mailing Address - Country:US
Mailing Address - Phone:619-737-2937
Mailing Address - Fax:619-266-6044
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 301-7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3707
Practice Address - Country:US
Practice Address - Phone:619-261-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111579106H00000X
106H00000X
CA106H00000X
CA73818106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist