Individual
NICOLE DOMINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LLP
Contact information
Practice address
29750 HARPER AVE, SAINT CLAIR SHORES, MI 48082-2607
(586) 777-3200
(586) 777-7855
Mailing address
42669 GARFIELD RD, CLINTON TWP, MI 48038-5036
(586) 412-5321
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301011786
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
750910681
BLUE CROSS
MI
Enumeration date
02/16/2009
Last updated
09/12/2025
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