| 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 | 104100000X Social Worker (Licence: IN 34009080A) |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2023-01-11 |