Individual
JACQUELINE DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10 FARRAGUT AVE, COLORADO SPRINGS, CO 80909-5626
(719) 636-2122
Mailing address
111 MACKENAN DR, CARY, NC 27511-7903
(919) 371-2848
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/24/2021
Last updated
01/02/2025
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