| 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 |