Dominique David
Individual provider Active NPI Professional Counselor · Salem, AL
NPI 1649637604 · NPPES record last updated Feb 14, 2023
Key facts
- NPI
- 1649637604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC012370 (GA)
- Practice address
- 3000 Lee Road 279
Salem, AL 36874-4776 - Phone
- (706) 617-4315
- NPI assigned
- Jan 21, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
10125 Polo Park Cir
Waco, TX 76712-8348
2100 Comer Ave
Columbus, GA 31904-8725
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260222000107 | GA | Practitioner - Mental Health Counselor | 5496236085 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC012370 | GA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Horizons Area MH Mr Sa Program | Current |
Accepting new patients |
Locations
2100 Comer Ave
Columbus, GA 31904
Phone (706) 323-0174
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC012370 | GA | Yes |
| Counselor | 101Y00000X |
Addresses
Primary practice location
3000 Lee Road 279
Salem, AL 36874-4776
Mailing address
3000 Lee Road 279
Salem, AL 36874-4776
Phone (706) 617-4315
Other providers in Salem, AL
- Dorothy Adkins
- Heather Andrews
- Ida Aspinall
- Angela L. Blackman
- Stephanie L Bruce
- Amanda Shiri Hill
- Johnson'S Express, Inc.
- Keldin Patricia Jones
- Alicia F Maiden
- Michelle Ashley Shields Maki
All providers in Salem, AL · Professional Counselor in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.