Provider Demographics
NPI:1093245045
Name:MORGAN, DOMINIQUE IRIA'N
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:IRIA'N
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:70453-0878
Mailing Address - Country:US
Mailing Address - Phone:225-367-0272
Mailing Address - Fax:
Practice Address - Street 1:328 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2710
Practice Address - Country:US
Practice Address - Phone:985-606-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty