Organization
YOUTH SUBSTANCE ABUSE COALITION
Active
Other names
EPIC
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH DERICKSON LCSW (THERAPIST)
(573) 587-1921
Entity
Organization
Contact information
Practice address
210 N SPRIGG ST, CAPE GIRARDEAU, MO 63701-5530
(573) 578-1921
Mailing address
210 N SPRIGG ST, CAPE GIRARDEAU, MO 63701-5530
(573) 578-1921
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/02/2022
Last updated
08/03/2022
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