Individual
DERWIN SAMUEL ISAIAH II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1914 BRUNSWICK AVE STE 1B, CHARLOTTE, NC 28207-1891
(704) 281-6356
Mailing address
1914 BRUNSWICK AVE STE 1B, CHARLOTTE, NC 28207-1891
(704) 281-6356
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10304
NC
Other
Enumeration date
06/12/2014
Last updated
05/08/2017
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