Individual
DOMINIQUE MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20955 BOURNEMOUTH ST, HARPER WOODS, MI 48225-2301
(313) 818-9825
Mailing address
17371 RUTHERFORD ST, DETROIT, MI 48235-3558
(313) 399-6406
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401018300
MI
Other
Enumeration date
01/13/2016
Last updated
09/09/2020
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