Provider Demographics
NPI:1932479581
Name:DODD, DARICE MARIE (EDS, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DARICE
Middle Name:MARIE
Last Name:DODD
Suffix:
Gender:F
Credentials:EDS, NCC, LPC
Other - Prefix:
Other - First Name:DARICE
Other - Middle Name:MARIE
Other - Last Name:MCDUFFIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, NCC, LPC
Mailing Address - Street 1:5542 HOMEWARD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2236
Mailing Address - Country:US
Mailing Address - Phone:404-345-1191
Mailing Address - Fax:
Practice Address - Street 1:5542 HOMEWARD LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-2236
Practice Address - Country:US
Practice Address - Phone:404-345-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005976101YP2500X
MO2012041490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional