Individual
DOMINIQUE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 E 7TH ST, CHARLOTTE, NC 28204-6300
(704) 461-3037
Mailing address
7311 BOWSPRIT CT, WENDELL, NC 27591-7278
(919) 633-0718
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/01/2019
Last updated
04/01/2019
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