Provider Demographics
NPI:1568938645
Name:DERRICK, DANIELLE PAIGE (LPC)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:PAIGE
Last Name:DERRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 E SOUTHERN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2568
Mailing Address - Country:US
Mailing Address - Phone:602-499-7590
Mailing Address - Fax:
Practice Address - Street 1:3740 E SOUTHERN AVE STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2568
Practice Address - Country:US
Practice Address - Phone:602-499-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health