Provider Demographics
NPI:1952431348
Name:DERRICK, BARBARA ANN (MDIV PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANN
Last Name:DERRICK
Suffix:
Gender:F
Credentials:MDIV PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 TRESTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-1824
Mailing Address - Country:US
Mailing Address - Phone:843-821-6532
Mailing Address - Fax:843-873-8728
Practice Address - Street 1:204 TRESTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-1824
Practice Address - Country:US
Practice Address - Phone:843-821-6532
Practice Address - Fax:843-873-8728
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC1717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional