Provider Demographics
NPI:1902559750
Name:MACKEY, DERICK JASON (BS)
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:JASON
Last Name:MACKEY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GLENWOOD LANE
Mailing Address - Street 2:150 GLENWOOD LANE
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5700
Mailing Address - Country:US
Mailing Address - Phone:205-969-2880
Mailing Address - Fax:
Practice Address - Street 1:GLENWOOD LANE
Practice Address - Street 2:150 GLENWOOD LANE
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5700
Practice Address - Country:US
Practice Address - Phone:205-969-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor