Provider Demographics
NPI:1134158090
Name:HIGHTOWER, DERRICK LAVON (LPCI)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:LAVON
Last Name:HIGHTOWER
Suffix:
Gender:M
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BITTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5865
Mailing Address - Country:US
Mailing Address - Phone:864-230-6479
Mailing Address - Fax:864-578-7176
Practice Address - Street 1:710 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5345
Practice Address - Country:US
Practice Address - Phone:864-230-6479
Practice Address - Fax:864-578-7176
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4714101YA0400X, 101YM0800X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health