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General NPI Number Information
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NPI Number | 1245111319
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Entity Type | Individual
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Provider Name | LATASHA DESHEA DERRICK-FEYISETAN LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 18383 PRESTON RD STE 404
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City | DALLAS
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State | TX
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Zip | 75252-5476
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Country | US
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Telephone | 214-280-1238
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 VILLAGE BEND DR APT 2103
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City | DALLAS
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State | TX
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Zip | 75206-3757
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Country | US
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Telephone | 214-280-1238
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 63305
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License Number State | TX
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