Individual
DEREK MAURICE TITUS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
165 MAIN ST STE A, CORTLAND, NY 13045-3049
(607) 753-0234
(607) 753-0286
Mailing address
2279 GREENWOOD RD APT 2, CORTLAND, NY 13045-9723
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
30023
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336163963
—
NY
Enumeration date
08/30/2018
Last updated
06/01/2022
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