Provider Demographics
NPI:1295872729
Name:DERMOTT, DAVID M (PSYD, LPA, LPC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:DERMOTT
Suffix:
Gender:M
Credentials:PSYD, LPA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DUNN PSYCHOLOGICAL ASSOCIATES, PA
Mailing Address - Street 2:P.O. BOX 487
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335-0487
Mailing Address - Country:US
Mailing Address - Phone:910-892-5839
Mailing Address - Fax:910-892-5771
Practice Address - Street 1:102 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5533
Practice Address - Country:US
Practice Address - Phone:910-892-5839
Practice Address - Fax:910-892-5839
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3185101YP2500X
NC2015103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC28060281Medicare UPIN
NC2817145Medicare ID - Type Unspecified