Individual
MR. DERRELL R. TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
432 30TH STREET, PORT TOWNSEND, WA 98368
(310) 670-4295
Mailing address
432 30TH STREET, PORT TOWNSEND, WA 98368
(310) 871-2954
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9609
CA
Other
Enumeration date
12/04/2006
Last updated
02/14/2024
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