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Individual

MRS. DEBRA MARIE DOMINCZAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC IT

Contact information

Practice address
1478 KENWOOD DR STE 1, MENASHA, WI 54952-1161
(920) 886-9319
(920) 886-9357
Mailing address
N6781 HARRISON RD, HILBERT, WI 54129-9262
(920) 989-2370

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1440-226
WI

Other

Enumeration date
02/13/2013
Last updated
02/13/2013
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