Individual
DOMIQUE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, SUPERVISEE
Contact information
Practice address
300 ARBORETUM PL, SUITE 502, NORTH CHESTERFIELD, VA 23236-3473
(804) 382-8099
Mailing address
300 ARBORETUM PL STE 502, NORTH CHESTERFIELD, VA 23236-3473
(804) 887-2990
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0906013267
VA
Other
Enumeration date
09/29/2023
Last updated
09/29/2023
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