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1407401086
DOMINIQUE MARIE SMITH
DEKALB, IL
NPI
1407401086
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2019-08-09
Last Update Date
2019-08-09
Business Address
DOMINIQUE MARIE SMITH BS
631 S 1ST ST
DEKALB, IL 60115-4117
Phone number: 815-756-8501
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Mailing Address
DOMINIQUE MARIE SMITH BS
PO BOX 1109
DEKALB, IL 60115-7109
Phone number: 815-756-8501
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