Individual
DOMINIQUE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1150 GRAHAM RD, FLORISSANT, MO 63031-8077
(314) 250-8277
Mailing address
5570 VERNON AVE, SAINT LOUIS, MO 63112-2756
(314) 546-9028
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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