Individual
MISS DOMINIQUE WILLIS- WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1111 HALSTEAD RD, PARKVILLE, MD 21234-6660
(301) 379-0271
Mailing address
1111 HALSTEAD RD, PARKVILLE, MD 21234-6660
(130) 137-9027
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
27777
MD
Other
Enumeration date
03/10/2023
Last updated
03/10/2023
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