Provider Demographics
NPI:1083941603
Name:MCLAUGHLIN, DOMINIQUE TAMARA
Entity Type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:TAMARA
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:TAMARA
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-0608
Mailing Address - Country:US
Mailing Address - Phone:540-967-2880
Mailing Address - Fax:540-967-0973
Practice Address - Street 1:500 OLD LYNCHBURG ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:23093-0608
Practice Address - Country:US
Practice Address - Phone:540-967-2880
Practice Address - Fax:540-967-0973
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health