Healthcare Provider Details

I. General information

NPI: 1982513701
Provider Name (Legal Business Name): MR. DEREK JAMAL TYLER SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 PACIFIC AVE STE 300
VIRGINIA BEACH VA
23451-2719
US

IV. Provider business mailing address

705 DISSDALE LN
CHESAPEAKE VA
23320-6859
US

V. Phone/Fax

Practice location:
  • Phone: 757-222-4944
  • Fax:
Mailing address:
  • Phone: 504-931-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019489
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: