Provider Demographics
NPI:1720451529
Name:HERRING, DERICK
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:
Last Name:HERRING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SUNDAY SILENCE LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-7121
Mailing Address - Country:US
Mailing Address - Phone:803-938-4792
Mailing Address - Fax:803-678-4534
Practice Address - Street 1:216 SUNDAY SILENCE LN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-7121
Practice Address - Country:US
Practice Address - Phone:803-938-4792
Practice Address - Fax:803-678-4534
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator