Individual
MARCIA DOMECQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3500 TOWER AVE, ESSENTIA HEALTH ST, MARY'S-SUPERIOR CLINIC, SUPERIOR, WI 54880-4491
(715) 817-7100
Mailing address
3500 TOWER AVE, ESSENTIA HEALTH ST, MARY'S-SUPERIOR CLINIC, SUPERIOR, WI 54880-4491
(715) 817-7100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3965-123
WI
Other
Enumeration date
04/30/2008
Last updated
12/02/2015
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