| NPI | 1962816371 |
|---|---|
| Former Name | JOELLE M DOMINGOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17029-130) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2017-01-11 |