Individual
WIESIA DOMANSKA-MIVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1412 W WASHINGTON ST, BOISE, ID 83702-5038
(208) 957-0957
Mailing address
1412 W WASHINGTON ST, BOISE, ID 83702-5038
(208) 957-0957
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5133
ID
101YP2500X
Professional Counselor
60570
TX
Other
Enumeration date
06/05/2007
Last updated
10/25/2013
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