Individual provider · Type 1 NPI
Derrick Bacon
Mental Health Counselor · Philadelphia, PA
NPI number
1083102180
Active
Practice location
906 69th Ave
Philadelphia, PA 19126-2909
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | None listed |
Mental Health Counselor: Definition to come...
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About NPI 1083102180
Derrick Bacon's National Provider Identifier is 1083102180, issued on Apr 25, 2018. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Philadelphia, PA. The record was last updated on Apr 25, 2018.