Provider Demographics
NPI:1942406954
Name:HUNEYCUTT, DOMINIQUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:
Last Name:HUNEYCUTT
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:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-1611
Mailing Address - Country:US
Mailing Address - Phone:828-412-5772
Mailing Address - Fax:828-412-5771
Practice Address - Street 1:12 RAVENSCROFT DR FL 2
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3637
Practice Address - Country:US
Practice Address - Phone:828-412-5772
Practice Address - Fax:828-412-5771
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3401103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ66016AOtherPTAN
NC6001036Medicaid