Dominique Willock

NPI #1053073189 in Mcdonough, Georgia

Provider Information

NPI Number: 1053073189
Entity Type: Individual
Name: Dominique Willock
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Behavior Technician
Enumeration Date: Oct 6, 2021
Last Updated: Oct 6, 2021

Practice Location

Address: 1624 BENNETT DR
City: Mcdonough
State: Georgia
ZIP Code: 30253-9010
Phone: (516) 808-0591

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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