Organization
SHEMIAH R DERRICK INC.
Active
Other names
Profound Peace Psychotherapy Collective
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEMIAH R. DERRICK LPC, CADC (PRESIDENT & OWNER)
(773) 424-2007
Entity
Organization
Contact information
Practice address
6127 S UNIVERSITY AVE STE 109, CHICAGO, IL 60637-5894
(773) 424-2007
Mailing address
6127 S UNIVERSITY AVE STE 109, CHICAGO, IL 60637-5894
(773) 424-2007
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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