Provider Demographics
NPI:1184332223
Name:DARE, MELISA (LMSW)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:
Last Name:DARE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:DORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1015 CORPORATE SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-344-6700
Mailing Address - Fax:314-344-6194
Practice Address - Street 1:1015 CORPORATE SQUARE DRIVE
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-344-6700
Practice Address - Fax:314-344-6194
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021037371104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker