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General NPI Number Information
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NPI Number | 1982513701
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Entity Type | Individual
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Provider Name | MR. DEREK JAMAL TYLER SR.
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Gender | Male
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Dates
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Enumeration Date | 09/07/2026
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Last Update Date | 09/07/2026
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Provider Practice Location Address
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Address Line | 3704 PACIFIC AVE STE 300
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-2719
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Country | US
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Telephone | 757-222-4944
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Fax |
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Provider Business Mailing Address
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Address Line | 705 DISSDALE LN
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City | CHESAPEAKE
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State | VA
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Zip | 23320-6859
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Country | US
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Telephone | 504-931-7110
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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 | 0704019489
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License Number State | VA
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