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General NPI Number Information
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NPI Number | 1629574090
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Entity Type | Individual
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Provider Name | DERRICK JAVAN HOARD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 116 DUGOUT LN
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City | STERLINGTON
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State | LA
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Zip | 71280-3317
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Country | US
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Telephone | 318-732-7489
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Fax |
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Provider Business Mailing Address
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Address Line | 116 DUGOUT LN
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City | STERLINGTON
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State | LA
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Zip | 71280-3317
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6489
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1291
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 60822202
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License Number State | WA
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