Provider Demographics
NPI:1790140986
Name:CECIL, DOMINIQUE (LPC)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:CECIL
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 1:205 20TH STREET NORTH SUITE 600
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203
Mailing Address - Country:US
Mailing Address - Phone:205-447-0585
Mailing Address - Fax:205-801-5169
Practice Address - Street 1:205 20TH STREET NORTH SUITE 600
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203
Practice Address - Country:US
Practice Address - Phone:205-447-0585
Practice Address - Fax:205-801-5169
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL137728Medicaid