Individual
DOMINIQUE COMMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5192 HIGHWAY 11 N, ELLISVILLE, MS 39437-5050
(601) 649-7921
(601) 649-7939
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1901
(601) 705-1952
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
5506
MS
Other
Enumeration date
08/11/2022
Last updated
08/11/2022
About Stedi
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