EBONY NICOLE DERRICKSON

LOGANVILLE, GA
NPI1881336907
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor Mental Health
Additional Taxonomies101Y00000X Counselor
103TC1900X Psychologist Counseling
Enumeration Date2022-04-09
Last Update Date2022-04-09
Business Address
MS. EBONY NICOLE DERRICKSON MS DDP
125 LEE BYRD RD
LOGANVILLE, GA 30052-2310
Phone number: 678-883-8609
Mailing Address
MS. EBONY NICOLE DERRICKSON MS DDP
750 GAINES SCHOOL RD APT I156
ATHENS, GA 30605-3254
Phone number: 706-296-4666