Provider Demographics
NPI:1245111319
Name:DERRICK-FEYISETAN, LATASHA DESHEA (LMSW)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:DESHEA
Last Name:DERRICK-FEYISETAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 VILLAGE BEND DR APT 2103
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3757
Mailing Address - Country:US
Mailing Address - Phone:214-280-1238
Mailing Address - Fax:
Practice Address - Street 1:18383 PRESTON RD STE 404
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5476
Practice Address - Country:US
Practice Address - Phone:214-280-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker