Individual
MRS. KATHLEEN C. DERISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12695 MCMANUS BLVD, BLDG. 8, NEWPORT NEWS, VA 23602-4435
(757) 877-7700
Mailing address
205 LAKEWOOD PARK DR, NEWPORT NEWS, VA 23602-6261
(757) 877-8765
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904000534
VA
Other
Enumeration date
08/10/2006
Last updated
07/08/2007
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