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General NPI Number Information
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NPI Number | 1265312086
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Entity Type | Individual
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Provider Name | NATHAN GILBERT DERRICKSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 400 W CAPITOL AVE STE 1700
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City | LITTLE ROCK
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State | AR
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Zip | 72201-3438
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Country | US
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Telephone | 646-941-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 11 ESTES WAY
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City | SOUTHSIDE
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State | AR
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Zip | 72501-7049
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Country | US
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Telephone | 417-399-1881
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12124-C
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License Number State | AR
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