Individual
DOMONIQUE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 331-3435
Mailing address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 331-3435
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6852090349
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/16/2021
Last updated
07/23/2025
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