Most Relevant Information
Provider Data
| NPI Number: | 1003525072 |
| Provider Name: | DOMONIQUE RICHARDSON |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/18/2022 |
| Last Updated: | 11/18/2022 |
Provider Practice Location
10340 DEMOCRACY LN STE BAND103
FAIRFAX
VA
220302518
Practice Location Phone/Fax
| Phone: | 5713860871 |
| Fax: |
Provider Mailing Location
5850 GRANITE PKWY STE 600
PLANO
TX
750246753
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |