Provider Demographics
NPI:1902218977
Name:LEVEILLE, DOMINIQUE C (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:C
Last Name:LEVEILLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15715 S DIXIE HWY STE 325
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1883
Mailing Address - Country:US
Mailing Address - Phone:305-967-3900
Mailing Address - Fax:305-922-3436
Practice Address - Street 1:15715 S DIXIE HWY STE 325
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1883
Practice Address - Country:US
Practice Address - Phone:305-922-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist