Provider Demographics
NPI:1164060976
Name:MONTANO, DOMINICA (LCSW)
Entity Type:Individual
Prefix:
First Name:DOMINICA
Middle Name:
Last Name:MONTANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-2302
Mailing Address - Country:US
Mailing Address - Phone:505-288-1105
Mailing Address - Fax:
Practice Address - Street 1:235 HACKBERRY DR
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-2302
Practice Address - Country:US
Practice Address - Phone:505-288-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-110361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty