Provider Demographics
NPI:1598309981
Name:ROSE, DOMINIQUE DENA (LPC)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:DENA
Last Name:ROSE
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 1:9494 HUMBLE WESTFIELD RD APT 3024
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5294
Mailing Address - Country:US
Mailing Address - Phone:832-878-3483
Mailing Address - Fax:
Practice Address - Street 1:505 N BELTWAY 8 STE 264E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4059
Practice Address - Country:US
Practice Address - Phone:281-656-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
79453101YA0400X
TX79453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)