Individual provider Active NPI

Adalia Joanne Dominique

  • Behavior Technician
  • Laurel, MD
National Provider Identifier
1194369108
Registry record updated Nov 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
10 Riverview CT Apt 103
Laurel, MD 20707-4137
Phone
(443) 743-4466
NPI assigned
Nov 1, 2019
Last updated
Nov 1, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X NU Primary

Addresses

Primary practice location

10 Riverview CT Apt 103
Laurel, MD 20707-4137

Mailing address

10 Riverview CT Apt 103
Laurel, MD 20707-4137
Phone (443) 743-4466

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240925001170 MD Practitioner - Mental Health Counselor 6507307931 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Counseling LLC CurrentSince Sep 9, 2024 Accepting new patients
Divine Counseling LLC CurrentSince Sep 9, 2024 Accepting new patients

Locations

90 Painters Mill Rd
Ste 135136
Owings Mills, MD 21117
Phone (443) 955-2662

1829 Reisterstown Rd
Ste 350
Pikesville, MD 21208
Phone (443) 226-1676

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1194369108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 RIVERVIEW CT APT 103",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074137",
            "telephone_number": "443-743-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 RIVERVIEW CT APT 103",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074137",
            "telephone_number": "443-743-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINIQUE",
        "first_name": "ADALIA",
        "middle_name": "JOANNE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-01",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

Verify at the official NPI Registry.