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Individual

NICOLE DOMINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LICSW

Contact information

Practice address
4357 13TH AVE S STE 104, FARGO, ND 58103-7504
(701) 478-4480
(701) 478-4481
Mailing address
4357 13TH AVE S STE 104, FARGO, ND 58103-7504
(701) 478-4480
(701) 478-4481

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
23025
MN
1041C0700X
Clinical Social Worker
Primary
5293
ND

Other

Enumeration date
01/05/2017
Last updated
11/22/2024
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