Provider Demographics
NPI:1316411309
Name:CRUMP, DOMINIQUE SHERIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:SHERIE
Last Name:CRUMP
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19921 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3984
Mailing Address - Country:US
Mailing Address - Phone:313-310-1810
Mailing Address - Fax:
Practice Address - Street 1:26657 WOODWARD AVE STE 106
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1371
Practice Address - Country:US
Practice Address - Phone:248-573-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511162281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical