Most Relevant Information
Provider Data
| NPI Number: | 1003693953 |
| Provider Name: | DOMINIQUE LYNNE'E POWELL |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/13/2023 |
| Last Updated: | 09/13/2023 |
Provider Practice Location
306 N MAIN ST STE 1A
HINESVILLE
GA
313132562
Practice Location Phone/Fax
| Phone: | 9124153144 |
| Fax: | 8664674321 |
Provider Mailing Location
306 N MAIN ST STE 1A
HINESVILLE
GA
313132562
Provider Mailing Phone/Fax
| Phone: | 9124153144 |
| Fax: | 8664674321 |