Individual
DOMENIQUE NASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24600 NORTHWESTERN HWY, SOUTHFIELD, MI 48075-2471
(313) 790-2164
Mailing address
8301 16 1/2 MILE RD APT 55, STERLING HEIGHTS, MI 48312-1850
(313) 790-2164
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000000000000
—
MI
Enumeration date
01/13/2022
Last updated
11/07/2023
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