DOMINIQUE RUSSELL

GARY, IN
NPI1043980139
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YP2500X Counselor, Professional
(Licence: IL  178.017417)
Enumeration Date2021-09-20
Last Update Date2021-09-22
Business Address
DOMINIQUE RUSSELL MA,LPC
4520 W RIDGE RD LOT 214
GARY, IN 46408-1333
Phone number: 312-632-0460
Mailing Address
DOMINIQUE RUSSELL MA,LPC
4520 W RIDGE RD LOT 214
GARY, IN 46408-1333
Phone number: 312-632-0460
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