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NPI Code Detail

MEDICARE: MR. DERRICK TREVON DINGLE JR.

MEDICARE: MR. DERRICK TREVON DINGLE JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1952973059
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DERRICK TREVON DINGLE JR.
Provider Business Mailing Address
First Line : 208 KING ST
Second Line :
City : CAMDEN
State : SC
Zip : 29020-4720
Country : US
Telephone Number : 803-432-6902
Fax Number :
Provider Business Practice Location Address
First Line : 208 KING ST
Second Line :
City : CAMDEN
State : SC
Zip : 29020-4720
Country : US
Telephone Number : 803-432-6902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2021
Last Update Date : 07/16/2021

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