Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | ASW 18288 | CA |
NPI | 1013055219 |
---|---|
Provider Name | Ms. Laurene Ann Dominguez |
First Address | Oakland, CA 94606-1962 |
Second Address | San Francisco, CA 94110-3917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |