- Practice location
- 4255 Wade Green RD NW Ste 414, Kennesaw, GA 30144-1763
- Phone
- 678-213-2194
- Fax
- —
- Last updated
- August 18, 2026
Annie Derthick is a Psychologist, Clinical based in Kennesaw, GA. Annie Derthick practices in Kennesaw, GA and has the professional credentials of PHD. The NPI Number for Annie Derthick is 1689039422 and holds a License No. PS1563 (ME). The current practice location address for Annie Derthick is 4255 Wade Green RD NW Ste 414, Kennesaw, GA 30144-1763 and can be reached out via phone at 678-213-2194.
Provider Profile Details
- NPI Number
- 1689039422
- Provider Name
- Annie Derthick
- Credential
- PHD
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 4255 Wade Green RD NW Ste 414, Kennesaw, GA 30144-1763
- Phone Number
- 678-213-2194
- Primary Taxonomy
- Psychologist, Clinical · 103TC0700X
- Sole Proprietor
- No
- Provider Enumeration Date
- December 21, 2015
- Last Update Date
- August 18, 2026
- Certification Date
- August 18, 2026
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 4255 Wade Green RD NW Ste 414
Kennesaw, GA 30144-1763 - City
- Kennesaw
- State
- Georgia
- Zip
- 30144-1763
- Phone Number
- 678-213-2194
Provider Business Mailing Address Details
- Address
- 4800 N Scottsdale RD Ste 2500
Scottsdale, AZ 85251-7630 - City
- Scottsdale
- State
- AZ
- Zip
- 85251-7630
License Information
- License Number (1)
- PS1563
- License State (1)
- ME
- Taxonomy (1)
- Psychologist, Family · 103TF0000X
- License Number (2)
- 107779
- License State (2)
- AK
- Taxonomy (2)
- Psychologist · 103T00000X
- License Number (3)
- PSY900357
- License State (3)
- GA
- Taxonomy (3)
- Psychologist, Clinical · 103TC0700X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Annie Derthick, PHD?
The NPI number of Annie Derthick, PHD is 1689039422. It was assigned on December 21, 2015 and is currently active in the NPPES registry.
What is the specialty of Annie Derthick, PHD?
Annie Derthick, PHD is registered under the primary taxonomy Psychologist, Clinical (code 103TC0700X), licensed in ME under license number PS1563.
Where does Annie Derthick, PHD practice?
The practice location is 4255 Wade Green RD NW Ste 414, Kennesaw, GA 30144-1763. The office can be reached at 678-213-2194 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1689039422 directly on the NPPES registry website.