Individual
DOMINIQUE PHUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 459-7215
Mailing address
3249 HUNTINGTON WOODS DR SE, APT F, KENTWOOD, MI 49512-8128
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3743369
MI
Other
Enumeration date
11/07/2015
Last updated
11/07/2015
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