Derrickson, Ebony Nicole

Derrickson, Ebony Nicole is an sole proprietor health care provider with primary practice located at 125 Lee Byrd Rd , Loganville GA 30052-2310. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Counseling, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Derrickson, Ebony Nicole can be contacted via phone (678) 883-8609.

Contact Information

Primary practice address
125 Lee Byrd Rd Loganville GA 30052-2310
Phone: (678) 883-8609
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / Counseling 103TC1900X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X Georgia

Profile Details

NPI number 1881336907
LBN Legal business name Derrickson, Ebony Nicole
Credentials MS DDP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 9th, 2022
Last updated Apr 9th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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