Domonique Mackey

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1495320123 Issued in CA

Practice address

1889 W Redlands Blvd BLDG 9
Redlands, CA 92373-3119

Phone

(909) 501-5167

NPI assigned

Feb 7, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Aegis Treatment Centers, LLC

  • Methadone Clinic
  • Redlands, CA
  • NPI 1992219646
  NPD (past)

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1366148686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1889 W REDLANDS BLVD BLDG 9",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733119",
            "telephone_number": "909-501-5167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1889 W REDLANDS BLVD BLDG 9",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733119",
            "telephone_number": "909-501-5167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKEY",
        "first_name": "DOMONIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-07",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1495320123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Leann Mabie, FNP-C
• Mohsen I Mabudian, M.D.
• Madeline Mace, AMFT
• Carlos Aitor Macias, MD, MPH, FACS
• Liberty Macias, PMHNP-BC
• Kala Marie Maclaughlan, PHARMD
• Christina Maclean, PA-C
• Kelly Ann Macwilkinson, LCSW
• Madeline C Douglas
• Maefers LLC

• Addiction (Substance Use Disorder) Counselor in Redlands, CA
• Providers in Redlands, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.