Individual
DOMINIQUE CASILLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1910 S PALMETTO AVE APT 105, SOUTH DAYTONA, FL 32119-2254
(203) 808-0402
Mailing address
1910 S PALMETTO AVE APT 105, SOUTH DAYTONA, FL 32119-2254
(203) 808-0402
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
03/29/2023
Last updated
10/17/2024
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