Individual
CHRISTOPHER DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED SOCIAL WORK
Contact information
Practice address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
Mailing address
2747 S AVERS AVE, CHICAGO, IL 60623-4510
(708) 336-9208
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37399
IL
1041C0700X
Clinical Social Worker
Primary
149.025775
IL
Other
Enumeration date
01/09/2023
Last updated
05/16/2024
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