Provider Demographics
NPI:1598036600
Name:DRIESSEN ESPANA, DOMINIQUE (LPC)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:DRIESSEN ESPANA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7370 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE E-10
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:843-422-5290
Mailing Address - Fax:
Practice Address - Street 1:7370 MEMORIAL DRIVE
Practice Address - Street 2:SUITE E-10
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:843-422-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2010-R101YA0400X
GA006663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)