Individual
DERRICK WARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
308 E UPSAL ST, PHILADELPHIA, PA 19119-2347
(215) 260-0452
Mailing address
308 E UPSAL ST, PHILADELPHIA, PA 19119-2347
(215) 260-0452
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/14/2012
Last updated
09/14/2012
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