Individual
RAVEN DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., TLLP
Contact information
Practice address
1257 KIRTS BLVD APT 218, TROY, MI 48084-4833
(248) 787-2173
Mailing address
1257 KIRTS BLVD APT 218, TROY, MI 48084-4833
(248) 787-2173
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6352000746
MI
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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