Individual
DOMINIQUE AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 W WILLIAMS ST, SUITE G, BOISE, ID 83706-3564
(208) 352-0803
Mailing address
2302 N 14TH ST, BOISE, ID 83702-1109
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-5677
ID
Other
Enumeration date
12/22/2014
Last updated
12/22/2014
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