Individual
DOMINIQUE MICHELLE MANGANO MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
13471 W CORNERSTONE BLVD, GOODYEAR, AZ 85395-2713
(480) 964-2273
Mailing address
19819 W MARSHALL AVE, LITCHFIELD PARK, AZ 85340-5426
(708) 209-9952
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-22735
AZ
Other
Enumeration date
04/25/2024
Last updated
05/01/2024
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