Provider Demographics
NPI:1750727236
Name:HARTWELL, DERRICK DURELL (LLMSW, CADC, CCS-D)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:DURELL
Last Name:HARTWELL
Suffix:
Gender:M
Credentials:LLMSW, CADC, CCS-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5503
Mailing Address - Country:US
Mailing Address - Phone:517-291-0587
Mailing Address - Fax:
Practice Address - Street 1:405 W GREENLAWN AVE # 100
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2898
Practice Address - Country:US
Practice Address - Phone:517-291-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102071101Y00000X, 101YA0400X, 101YM0800X, 1041C0700X
MI680141564101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health