Individual
DOMINIQUE JALISIA MICKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
360 CENTRAL AVE STE 1230, ST PETERSBURG, FL 33701-3865
(172) 756-5242
Mailing address
706 12TH ST E, BRADENTON, FL 34208-2120
(941) 920-8436
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW22641
FL
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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