Individual
MARC ADRIAN DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3110 CLEVELAND BLVD STE D, CALDWELL, ID 83605-5539
(208) 614-6752
Mailing address
3110 CLEVELAND BLVD STE D, CALDWELL, ID 83605-5539
(208) 614-6752
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-42533
ID
Other
Enumeration date
02/06/2020
Last updated
06/15/2023
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