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General NPI Number Information
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NPI Number | 1942192760
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Entity Type | Individual
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Provider Name | DERRICK THOMAS
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Gender | Male
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 5612 BLAINE ST NE
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City | WASHINGTON
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State | DC
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Zip | 20019-6767
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Country | US
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Telephone | 202-500-6843
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Fax |
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Provider Business Mailing Address
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Address Line | 4015 ALABAMA AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-6013
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Country | US
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Telephone | 227-206-9827
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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 |
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License Number State |
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