Individual
DERRICK ANTHONY DEPETRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS, CADC
Contact information
Practice address
104 MALTON RD, NEGAUNEE, MI 49866-2000
(906) 228-4692
(906) 228-2830
Mailing address
104 MALTON RD, NEGAUNEE, MI 49866-2000
(906) 228-4692
(906) 228-2830
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2-00996
MI
Other
Enumeration date
07/07/2017
Last updated
06/01/2022
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