Individual
RENE BETH DOMASK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
760 QUARTERDECK LN # 2102B, STURGEON BAY, WI 54235-3639
(920) 851-6404
Mailing address
760 QUARTERDECK LN # 2102B, STURGEON BAY, WI 54235-3639
(920) 851-6404
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6882-125
WI
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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