Provider Demographics
NPI:1184842593
Name:DOMBO, EILEEN ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:ANNE
Last Name:DOMBO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 LEGATION ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1711
Mailing Address - Country:US
Mailing Address - Phone:202-423-9509
Mailing Address - Fax:
Practice Address - Street 1:1555 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 401
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1111
Practice Address - Country:US
Practice Address - Phone:202-423-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3035141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical