Provider Demographics
NPI:1871871822
Name:FORD, DEREK (PHD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 NEFF AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3429
Mailing Address - Country:US
Mailing Address - Phone:540-433-2858
Mailing Address - Fax:540-433-1175
Practice Address - Street 1:312 NEFF AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3429
Practice Address - Country:US
Practice Address - Phone:540-433-2858
Practice Address - Fax:540-433-1175
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical