Individual
MRS. CARLA R. GUTIERREZ DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
671 S LEWIS AVE, WAUKEGAN, IL 60085-6101
(847) 782-4156
(847) 782-1030
Mailing address
671 S LEWIS AVE, WAUKEGAN, IL 60085-6101
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.018983
IL
Other
Enumeration date
03/31/2016
Last updated
01/03/2017
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