Male or Other

Mr. Derrell R. Tidwell LCSW

Clinical Social Worker in Port Townsend, WA(View on Map)

Full Name

Mr. Derrell R. Tidwell LCSW

NPI Number

1871661074

NPI Type

Individual Provider

Gender

Male

Enumeration Date

12/04/2006

Specialties

(Taxonomies)

Code

1041C0700X

Primary Taxonomy

Yes

Licenses

State

California

License Number

9609

Contact
Information

Purpose

Mailing
Location

Address

432 30TH STREET
432 30TH STREET

City

Port Townsend
Port Townsend

State

WA
WA

Postal Code

98368
98368

Country

US
US

Telephone Number

(310) 871-2954
(310) 670-4295

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 02/14/2024

Provider Address

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