Derrik Richard Haithcock Sr., LCDC LLL

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCDCIII.161470 Issued in OH

Practice address

1071 Tong Hollow Rd
Bainbridge, OH 45612-1500

Phone

(740) 634-3094

NPI assigned

May 14, 2018

Last updated

Apr 10, 2019By the provider in NPPES

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/lys/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lighthouse Youth Services Inc.

  dba Lighthouse Youth & Family Services

  • Addiction (Substance Use Disorder) Counselor
  • Bainbridge, OH
  • NPI 1053389841
  NPD (past)

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1922598143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E MCMILLAN ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452061922",
            "telephone_number": "513-221-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 TONG HOLLOW RD",
            "city": "BAINBRIDGE",
            "state": "OH",
            "postal_code": "456121500",
            "telephone_number": "740-634-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAITHCOCK",
        "first_name": "DERRIK",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "LCDC LLL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-14",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCIII.161470",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Gomez
• Jarrod William Gozy
• Samantha Graves
• Carol Greene
• Chandler Wayne Grooms, QMHS
• Shelby Marlene Hale
• Nikole Hamilton
• Navin Hardeo
• Ilisha Harris
• Robyn Hefter

• Addiction (Substance Use Disorder) Counselor in Bainbridge, OH
• Providers in Bainbridge, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.