Provider Demographics
NPI:1497185078
Name:DOMINGUEZ, ALLYSON LEIGH (MS MHC)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:LEIGH
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MS MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3602
Mailing Address - Country:US
Mailing Address - Phone:305-667-1036
Mailing Address - Fax:305-234-5459
Practice Address - Street 1:5711 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3602
Practice Address - Country:US
Practice Address - Phone:305-667-1036
Practice Address - Fax:305-234-5459
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health