Individual
DOMINIQUE RENEE STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24077 CA-49, NEVADA CITY, CA 95959
(530) 265-9057
Mailing address
201 D ST STE G, MARYSVILLE, CA 95901-5957
(530) 742-7747
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
42288
CA
Other
Enumeration date
09/07/2018
Last updated
09/22/2022
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