Gist, Dominique L

Gist, Dominique L is an sole proprietor health care provider with primary practice located at 8674 S 165Th Ave , Goodyear AZ 85338-1447. She recently has 5 registered licenses in different health care specialties including Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness, Agencies / Community/Behavioral Health, Residential Treatment Facilities / Substance Abuse Rehabilitation Facility, Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy, Residential Treatment Facilities / Psychiatric Residential Treatment Facility. Residential Treatment Facilities / Psychiatric Residential Treatment Facility is her primary health care specialty. Gist, Dominique L can be contacted via phone (313) 434-6821.

Contact Information

Primary practice address
8674 S 165Th Ave Goodyear AZ 85338-1447
Phone: (313) 434-6821
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness 320800000X
Agencies / Community/Behavioral Health 251S00000X
Residential Treatment Facilities / Substance Abuse Rehabilitation Facility 324500000X
Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X
Residential Treatment Facilities / Psychiatric Residential Treatment Facility 323P00000X

Profile Details

NPI number 1629674742
LBN Legal business name Gist, Dominique L
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 5th, 2020
Last updated Dec 5th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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