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Individual
DOMINIQUE L GIST
Active
Individual
DOMINIQUE L GIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NULL
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
NULL
324500000X
Substance Abuse Rehabilitation Facility
—
NULL
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
NULL
Other
Enumeration date
12/05/2020
Last updated
12/05/2020
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