Individual
DOMINIQUE TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
1110 13TH ST STE D, COLUMBUS, GA 31901-2246
(706) 641-2462
Mailing address
2607 1ST AVE, PHENIX CITY, AL 36867-4103
(706) 393-1569
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
8673125
AL
Other
Enumeration date
11/01/2024
Last updated
11/01/2024
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