Individual
MS. DOMONIQUE W BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 FIRST STREET SOUTH EXT STE D, COLUMBIA, SC 29209-3559
(803) 446-3209
Mailing address
1101 FIRST STREET SOUTH EXT STE D, COLUMBIA, SC 29209-3559
(803) 446-3209
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
05/23/2025
Last updated
05/23/2025
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