Healthcare Provider Details

I. General information

NPI: 1104753342
Provider Name (Legal Business Name): DARE TO BE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 VILLAGE WAY
CANTON MI
48188-3449
US

IV. Provider business mailing address

PO BOX 223
DEXTER MI
48130-0223
US

V. Phone/Fax

Practice location:
  • Phone: 734-560-8534
  • Fax:
Mailing address:
  • Phone: 734-560-8534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: KAYLA LYNN DOUGLAS
Title or Position: CO-FOUNDER
Credential: LMSW
Phone: 734-560-8534