Individual
MS. DEIDRE LAROYCE STANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5795 DE GIVERVILLE AVE, SAINT LOUIS, MO 63112-1638
(314) 401-1640
Mailing address
5795 DE GIVERVILLE AVE, SAINT LOUIS, MO 63112-1638
(314) 401-1640
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2002008273
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002008273
MO LCSW NUMBER
MO
Enumeration date
03/01/2007
Last updated
07/09/2007
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