Provider Demographics
NPI:1710248950
Name:WALKER, DOMINIQUE (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 MONTAUK HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4400
Mailing Address - Country:US
Mailing Address - Phone:631-835-9886
Mailing Address - Fax:
Practice Address - Street 1:631 MONTAUK HWY STE 7
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4400
Practice Address - Country:US
Practice Address - Phone:631-835-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health