Dominique Dijkhuizen, LCSW

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

1689148397 Issued in CO

Practice address

101 Lanark TRL
Southern Pines, NC 28387-7513

Phone

(719) 270-1722

NPI assigned

Jan 15, 2019

Sex

Female

Sole proprietor

Yes

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)

Enrolled

State licenses

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1689148397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 COMMERCE AVE # 189",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283877059",
            "telephone_number": "719-270-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LANARK TRL",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283877513",
            "telephone_number": "719-270-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIJKHUIZEN",
        "first_name": "DOMINIQUE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-15",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CO",
            "license": "1689148397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Melissa Leigh Dixon, MA, BCBA, LBA
• Traci Lynn Dolbeer, PA-C

• Adult Mental Health Clinic/Center in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Adult Mental Health Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.