# DOMINIQUE L GIST

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1629674742
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |
| 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