Healthcare Provider Details

I. General information

NPI: 1316852668
Provider Name (Legal Business Name): DERRICKLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 OLD PARK ROW
MONTGOMERY AL
36117-4394
US

IV. Provider business mailing address

1325 OLD PARK ROW
MONTGOMERY AL
36117-4394
US

V. Phone/Fax

Practice location:
  • Phone: 334-324-6430
  • Fax:
Mailing address:
  • Phone: 334-324-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE LEFLORE WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 334-467-6776