Provider Demographics
NPI:1417647082
Name:JONES, DOMINIQUE SYMONE (MHCA)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:SYMONE
Last Name:JONES
Suffix:
Gender:F
Credentials:MHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 MANDAN RD APT 303
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2852
Mailing Address - Country:US
Mailing Address - Phone:301-741-5120
Mailing Address - Fax:
Practice Address - Street 1:3430 SW 320TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2292
Practice Address - Country:US
Practice Address - Phone:609-925-3289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health