Provider Demographics
NPI:1265425805
Name:CHANCE, DARISSA D (LMSW)
Entity type:Individual
Prefix:
First Name:DARISSA
Middle Name:D
Last Name:CHANCE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DARISSA
Other - Middle Name:D
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1527 ALBIA RD
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-3907
Mailing Address - Country:US
Mailing Address - Phone:641-799-6528
Mailing Address - Fax:641-682-1924
Practice Address - Street 1:1527 ALBIA RD
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3907
Practice Address - Country:US
Practice Address - Phone:641-682-8772
Practice Address - Fax:641-682-1924
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06258104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAT016OtherTRIWEST
IA0421537Medicaid
IA221801OtherIOWA HEALTH SOLUTIONS
IA221801OtherIOWA HEALTH SOLUTIONS