Individual
MR. DERRIK RICHARD HAITHCOCK SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDC LLL
Contact information
Practice address
1071 TONG HOLLOW RD, BAINBRIDGE, OH 45612-1500
(740) 634-3094
Mailing address
401 E MCMILLAN ST, CINCINNATI, OH 45206-1922
(513) 221-3350
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.161470
OH
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/14/2018
Last updated
04/10/2019
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