Individual
VICTORIA NICOLE DOMENECH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2810 ASHLEY PHOSPHATE RD, NORTH CHARLESTON, SC 29418-6405
(843) 813-1538
Mailing address
9345 BLUE HOUSE RD APT NO12205, LADSON, SC 29456-4076
(757) 648-0331
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-281009
SC
Other
Enumeration date
06/28/2023
Last updated
07/19/2023
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