Individual
DARLA D DERRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA QMHS CMS
Contact information
Practice address
3500 CARNEGIE AVE, CLEVELAND, OH 44115-2641
(440) 234-2006
Mailing address
3500 CARNEGIE AVE, CLEVELAND, OH 44115-2641
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.169875
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190828-001283
—
OH
Enumeration date
08/28/2019
Last updated
08/27/2020
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