Provider Demographics
NPI:1033839576
Name:MAXWELL, HALIE DOMINGUE (LCSW)
Entity Type:Individual
Prefix:
First Name:HALIE
Middle Name:DOMINGUE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HALIE
Other - Middle Name:DOMINGUE
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HALIE DOMINGUE
Mailing Address - Street 1:1348 HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4209
Mailing Address - Country:US
Mailing Address - Phone:512-751-3791
Mailing Address - Fax:
Practice Address - Street 1:1348 HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4209
Practice Address - Country:US
Practice Address - Phone:512-751-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26734161OtherDRIVER'S LICENSE