Individual provider · Type 1 NPI

Dominique Terrell Pettis

Addiction (Substance Use Disorder) Counselor · Colton, CA

NPI number 1184968570 Active

Practice location

2275 E. Cooley Dr
Colton, CA 92324

Call (909) 370-1777 Map

Fax (909) 370-1776

Mailing address

16519 Welsh Ct
Moreno Valley, CA 92555-3316

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XNone listed

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1184968570

Dominique Terrell Pettis's National Provider Identifier is 1184968570, issued on Nov 26, 2012. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Colton, CA. The record was last updated on Nov 26, 2012.