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1245111319 NPI number — LATASHA DESHEA DERRICK-FEYISETAN LMSW

NPI Number: 1245111319
Health Care Provider/Practitioner: LATASHA DESHEA DERRICK-FEYISETAN LMSW

Information about “1245111319” NPI (LATASHA DESHEA DERRICK-FEYISETAN LMSW) exists in 1245111319 in HTML format HTML  |  1245111319 in plain Text format TXT  |  1245111319 in PDF (Portable Document Format) PDF  |  1245111319 in an XML format XML  formats.

NPI Number : 1245111319 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245111319",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DERRICK-FEYISETAN",
    "FirstName": "LATASHA",
    "MiddleName": "DESHEA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6060 VILLAGE BEND DR APT 2103",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75206-3757",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-280-1238",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "18383 PRESTON RD STE 404",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75252-5476",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-280-1238",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/08/2025",
    "LastUpdateDate": "10/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "104100000X",
        "TaxonomyName": "Social Worker",
        "LicenseNumber": "63305",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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