Provider Demographics
NPI:1295761849
Name:AMPEY, DERRICK DUANE (LCSW)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:DUANE
Last Name:AMPEY
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 1:626 WESTMORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1969
Mailing Address - Country:US
Mailing Address - Phone:517-702-2653
Mailing Address - Fax:517-351-2733
Practice Address - Street 1:626 WESTMORELAND AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1969
Practice Address - Country:US
Practice Address - Phone:517-702-2653
Practice Address - Fax:517-351-2733
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801080800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker