Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 4714 | SC |
N | 101YM0800X | Mental Health Counselor | 4714 | SC |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4714 | SC |
NPI | 1134158090 |
---|---|
Provider Name | Derrick Lavon Hightower |
First Address | Taylors, SC 29687-5865 |
Second Address | Spartanburg, SC 29306-5345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 06/02/2012 |