Individual
MRS. DOMINIQUE JEROLDINE LEON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6216 SCOTTSVILLE RD, JEFFERSONTON, VA 22724-2342
(540) 219-3247
Mailing address
6216 SCOTTSVILLE RD, JEFFERSONTON, VA 22724-2342
(540) 219-3247
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904013714
VA
Other
Enumeration date
02/24/2022
Last updated
11/02/2023
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