Provider Demographics
NPI:1851976807
Name:LOTT, DERRICK D (LCDC)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:D
Last Name:LOTT
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18010 CABIN GREEN CT
Mailing Address - Street 2:
Mailing Address - City:ATASCOCITA
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3405
Mailing Address - Country:US
Mailing Address - Phone:903-944-8702
Mailing Address - Fax:
Practice Address - Street 1:18010 CABIN GREEN CT
Practice Address - Street 2:
Practice Address - City:ATASCOCITA
Practice Address - State:TX
Practice Address - Zip Code:77346-3405
Practice Address - Country:US
Practice Address - Phone:903-944-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12122101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)