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MR. DERRYCK VANCURK MOORE LADC
NPI 1336381599
Counselor - Addiction (Substance Use Disorder) in Plymouth, MN

Active since April 01, 2009
12400 25TH AVE N, PLYMOUTH, MN 55441(612) 220-8645(952) 405-8090 Get Directions Write a Review

NPPES record last updated: April 1, 2009. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Mr. Derryck Vancurk Moore Ladc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. DERRYCK VANCURK MOORE LADC (NPI 1336381599) is an individual addiction (substance use disorder) provider in Plymouth, Minnesota, licensed in Minnesota (301674) and active in the NPI registry since April 2009.

NPPES Registry Identity

NPI1336381599
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameMR. DERRYCK VANCURK MOORECredential: LADC
Location Address12400 25TH AVE NPlymouth, MN 55441-4008
Mailing Address12400 25th Ave NPlymouth, MN 55441-4008 · (612) 220-8645 · Fax (952) 405-8090
Phone(612) 220-8645
Fax(952) 405-8090
Sole ProprietorYes
Enumeration DateApril 1, 2009
✔ NPI 1336381599 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in MN · 301674
12400 25TH AVE N, Plymouth, MN 55441
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derryck Moore's NPI number?

The NPI number for Derryck Moore is 1336381599. It was assigned to this individual provider in the NPPES registry on April 1, 2009.

Where is Derryck Moore located?

Derryck Moore practices at 12400 25th Ave N, Plymouth, MN 55441. The listed phone number is (612) 220-8645.

What is Derryck Moore's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Derryck Moore was last updated on April 1, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.