NPI Code Detail JSON Logo

1881336907 NPI number — EBONY NICOLE DERRICKSON MS DDP

NPI Number: 1881336907
Health Care Provider/Practitioner: EBONY NICOLE DERRICKSON MS DDP

Information about “1881336907” NPI (EBONY NICOLE DERRICKSON MS DDP) exists in 1881336907 in HTML format HTML  |  1881336907 in plain Text format TXT  |  1881336907 in PDF (Portable Document Format) PDF  |  1881336907 in an XML format XML  formats.

NPI Number : 1881336907 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1881336907",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DERRICKSON",
    "FirstName": "EBONY",
    "MiddleName": "NICOLE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MS DDP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "750 GAINES SCHOOL RD APT I156",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ATHENS",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30605-3254",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-296-4666",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "125 LEE BYRD RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOGANVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30052-2310",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-883-8609",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/09/2022",
    "LastUpdateDate": "04/09/2022",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC1900X",
          "TaxonomyName": "Counseling Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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