Provider Demographics
NPI:1699037887
Name:DOMINGUE, RACHEL RENEE' (LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RENEE'
Last Name:DOMINGUE
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 1:102 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6085
Mailing Address - Country:US
Mailing Address - Phone:337-534-4083
Mailing Address - Fax:337-534-4088
Practice Address - Street 1:102 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6085
Practice Address - Country:US
Practice Address - Phone:337-534-4083
Practice Address - Fax:337-534-4088
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional