Provider Demographics
NPI:1013235928
Name:STEPHENS, DERRICK OMAR (LCSW)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:OMAR
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 WALLROCK CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4457
Mailing Address - Country:US
Mailing Address - Phone:407-770-7026
Mailing Address - Fax:
Practice Address - Street 1:256 WALLROCK CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4457
Practice Address - Country:US
Practice Address - Phone:407-770-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical