Provider Demographics
NPI:1891339966
Name:SINGLETON, DERRICK LEMONT
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:LEMONT
Last Name:SINGLETON
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:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:WELLPINIT
Mailing Address - State:WA
Mailing Address - Zip Code:99040-0540
Mailing Address - Country:US
Mailing Address - Phone:509-258-7502
Mailing Address - Fax:
Practice Address - Street 1:6233 OLD SCHOOL RD
Practice Address - Street 2:6233 OLD SCHOOL RD
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040
Practice Address - Country:US
Practice Address - Phone:509-258-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60274572101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor