Provider Demographics
NPI:1275220741
Name:JAMES, DOMINIQUE ALEXANDER (LPC)
Entity Type:Individual
Prefix:MR
First Name:DOMINIQUE
Middle Name:ALEXANDER
Last Name:JAMES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 N KENMORE AVE APT 507
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1549
Mailing Address - Country:US
Mailing Address - Phone:804-678-8502
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 231
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3670
Practice Address - Country:US
Practice Address - Phone:804-678-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional