Dominiquea Edmiston, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

20424 Issued in AZ

Practice address

806 Phillips LN
Statesville, NC 28625-4596

Phone

(602) 525-7997

NPI assigned

Apr 6, 2022

Last updated

Aug 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grounded in Growth Therapy LLC

  • Clinical Social Worker
  • Peoria, AZ
  • NPI 1598474868
  NPD

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

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722729600000",
    "number": "1619618212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 PHILLIPS LN",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254596",
            "telephone_number": "602-525-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 PHILLIPS LN",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254596",
            "telephone_number": "602-525-7997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1115 E Lemon St",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852814028",
            "country_code": "US",
            "telephone_number": "602-525-7997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDMISTON",
        "first_name": "DOMINIQUEA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-06",
        "last_updated": "2024-08-04",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AZ",
            "license": "18434",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "20424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dominiquealcsw@groundandgrowtherapy.com",
            "affiliation": "N",
            "endpointDescription": "encrypted email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "806 Phillips Ln",
            "city": "Statesville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286254596",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eastside Pharmacy Services, LLC (Banner Drug Downtown Satatesville)
• Nicole Marie Eaton, PA-C
• Eckerd Corporation (Rite Aid Pharmacy 11547)
• Ida Lee Eden, MS, CCC-SLP
• Kristen Eden, PT, DPT
• Amy Perras Eisele, LCSW
• Eldercenter Inc (Iredell Adult Day Services)
• Elevate Life Counseling PLLC
• Mariana Alyn Ellington, MD
• Phyllis Ellis Phifer

• Clinical Social Worker in Statesville, NC
• Providers in Statesville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.