Individual
DARRYL L WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
(314) 289-6543
Mailing address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
(314) 289-6543
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1999135425
MO
Other
Enumeration date
12/04/2015
Last updated
07/12/2024
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