Individual
DOMINIQUE WILLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1624 BENNETT DR, MCDONOUGH, GA 30253-9010
(516) 808-0591
Mailing address
1624 BENNETT DR, MCDONOUGH, GA 30253-9010
(516) 808-0591
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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