Provider Demographics
NPI:1982313037
Name:PARAMORE, DERRICK ANTHONY (MA)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:ANTHONY
Last Name:PARAMORE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VAN ZANDT PKWY
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-2375
Mailing Address - Country:US
Mailing Address - Phone:757-453-7077
Mailing Address - Fax:
Practice Address - Street 1:5301 PROVIDENCE RD STE 20
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4128
Practice Address - Country:US
Practice Address - Phone:757-347-8840
Practice Address - Fax:757-829-1667
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health