Individual
MR. DERIK GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, QMHP-T
Contact information
Practice address
291 INDEPENDENCE BLVD STE 532, VIRGINIA BEACH, VA 23462-5473
(757) 962-6889
Mailing address
291 INDEPENDENCE BLVD STE 532, VIRGINIA BEACH, VA 23462-5473
(757) 962-6889
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0734002974
VA
Other
Enumeration date
04/01/2021
Last updated
04/01/2021
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