| NPI | 1205267838 |
|---|---|
| Former Name | DOMINICK CHARLES ALLEN MAXEY |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2013-12-08 |
| Last Update Date | 2023-06-23 |