Provider Demographics
NPI:1891370961
Name:DOMINGUEZ, ANA JANETTE (RMHCI)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:JANETTE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 VILLA VERANO WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5979
Mailing Address - Country:US
Mailing Address - Phone:407-874-0249
Mailing Address - Fax:
Practice Address - Street 1:833 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5838
Practice Address - Country:US
Practice Address - Phone:786-714-3713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20506101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor