Individual
DOMINIQUE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5043 FRANKFORD AVE, PHILADELPHIA, PA 19124-2644
(215) 744-4343
Mailing address
12203 BARBARY RD, PHILADELPHIA, PA 19154-1801
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/27/2019
Last updated
02/27/2019
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