Individual
DEREIK LANCE DOMERESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
905 NE RICE RD STE B, LEES SUMMIT, MO 64086-6300
(816) 223-8522
Mailing address
2410 SW STATE ROUTE 150, LEES SUMMIT, MO 64082-2903
(816) 223-8522
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
10198
KS
1041C0700X
Clinical Social Worker
Primary
2016034259
MO
Other
Enumeration date
01/03/2017
Last updated
06/15/2022
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