Provider Demographics
NPI:1750143020
Name:WILLIAMS, DERRICK DE ANDRE
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:DE ANDRE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:PROF
Other - First Name:DERRICK
Other - Middle Name:D
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:10138 HORSESHOE BEND DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-5340
Mailing Address - Country:US
Mailing Address - Phone:832-605-0023
Mailing Address - Fax:
Practice Address - Street 1:10138 HORSESHOE BEND DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-5340
Practice Address - Country:US
Practice Address - Phone:832-605-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral