Individual
NANCY VIOLA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
907 WEST BOND STREET, ESPANOLA, NM 87532
(505) 247-0081
Mailing address
907 WEST BOND STREET, ESPANOLA, NM 87532
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
X-05958
NM
Other
Enumeration date
09/14/2007
Last updated
09/14/2007
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