Individual
ANTHONY DERISO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8914 LIZZIE LN, HUNTERSVILLE, NC 28078-5614
(704) 560-6738
Mailing address
8914 LIZZIE LN, HUNTERSVILLE, NC 28078-5614
(704) 560-6738
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9620
NC
101YS0200X
School Counselor
1146772
NC
Other
Enumeration date
07/28/2022
Last updated
07/28/2022
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