Courtney Derrick, LPCC, LICDC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.2203162 Issued in OH

Practice address

3409 E Broad St
Columbus, OH 43213-1064

Phone

(380) 201-1101

NPI assigned

Sep 28, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714780800000",
    "number": "1194332676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4214 E MAIN ST",
            "city": "WHITEHALL",
            "state": "OH",
            "postal_code": "432133028",
            "telephone_number": "614-334-6903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131064",
            "telephone_number": "380-201-1101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8017 Canyon Rd SE",
            "address_purpose": "LOCATION",
            "city": "Hebron",
            "state": "OH",
            "postal_code": "430259301",
            "country_code": "US",
            "telephone_number": "304-673-3953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "COURTNEY",
        "credential": "LPCC, LICDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-28",
        "last_updated": "2024-05-04",
        "certification_date": "2024-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.161741",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.2203162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilclif Derolus
• Derosa Care Services, LLC
• Derosa Home Health Care, LLC
• Joseph Derr, CPNP-AC
• Derrick Mayo LLC
• Laura Derrickson, M.S., CCC-SLP
• Matthew Dershaw
• Deryck D. Richardson, PH.D. LLC
• Maud Des - Bordes
• Bijal J Desai, MD

• Mental Health Counselor in Columbus, OH
• Providers in Columbus, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.