Individual
ANNIE DERTHICK
Active
Individual
ANNIE DERTHICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
107779
AK
103T00000X
Psychologist
Primary
PSY900357
GA
103TC0700X
Clinical Psychologist
Primary
PSY900357
GA
103TF0000X
Family Psychologist
PS1563
ME
Other
Enumeration date
12/21/2015
Last updated
08/18/2026
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