| NPI | 1891382339 |
|---|---|
| Former Name | DOMINIQUE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34009080A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.028567) |
| 104100000X Social Worker (Licence: IN 34009080A) | |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2025-09-03 |