Provider Demographics
NPI:1497501472
Name:DERRICK, HAEVIN (BS)
Entity type:Individual
Prefix:
First Name:HAEVIN
Middle Name:
Last Name:DERRICK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:HAEVIN
Other - Middle Name:
Other - Last Name:DERRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:1908 WILD OAKS CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2288
Mailing Address - Country:US
Mailing Address - Phone:615-568-7806
Mailing Address - Fax:615-568-7806
Practice Address - Street 1:4555 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4585
Practice Address - Country:US
Practice Address - Phone:716-781-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health