Organization
ENVISION BEHAVIORAL HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA CIPOLETTI DERREBERRY MD (MANAGING MEMBER)
(304) 617-4337
Entity
Organization
Contact information
Practice address
2554 LEWISVILLE CLEMMONS RD STE 207, CLEMMONS, NC 27012-9752
(304) 617-4337
(339) 207-0143
Mailing address
100 STADIUM OAKS DR STE B, CLEMMONS, NC 27012-8961
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2016-01870
NC
Other
Enumeration date
05/25/2018
Last updated
06/10/2020
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