NPI | 1538704077 |
---|---|
Former Name | DOMINIQUE COLES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: 0904015105) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0906008225) |
Enumeration Date | 2019-11-07 |
Last Update Date | 2023-03-26 |