Individual
DOMINIQUE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11185 LAKE BLVD STE 205, CHISAGO CITY, MN 55013-9814
(952) 228-3487
Mailing address
17566 XINGU ST NE, COLUMBUS, MN 55025-8869
(651) 276-5894
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
02/14/2022
Last updated
02/14/2022
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