Individual
DERRICK MIKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
404 SANDS DR STE 2, ALBANY, GA 31705-2772
(229) 854-0589
Mailing address
801 SWIFT ST, ALBANY, GA 31705-1360
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC016713
GA
101YP1600X
Pastoral Counselor
Primary
—
—
Other
Enumeration date
09/28/2015
Last updated
04/23/2026
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