Individual
DERRICK LOREN SAMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, SUDT, MHP
Contact information
Practice address
12201 PACIFIC AVE S, TACOMA, WA 98444-5126
(253) 536-6425
Mailing address
5001 112TH ST E, TACOMA, WA 98446-5307
(253) 536-6425
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60749434
WA
101YM0800X
Mental Health Counselor
CG60832062
WA
Other
Enumeration date
10/24/2018
Last updated
11/08/2019
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