Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ||
N | 1041C0700X | Clinical Social Worker | NLC0110365 |
NPI | 1003458183 |
---|---|
Provider Name | Mrs. Raquel Dominguez |
First Address | Colorado Springs, CO 80918-2073 |
Second Address | Colorado Springs, CO 80918-2073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2019 |
Last Update Date | 03/03/2021 |