Provider Demographics
NPI:1013501469
Name:GARCIA-DOMINGUEZ, YAHAIRA (LCPC)
Entity Type:Individual
Prefix:
First Name:YAHAIRA
Middle Name:
Last Name:GARCIA-DOMINGUEZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3717
Mailing Address - Country:US
Mailing Address - Phone:872-444-0482
Mailing Address - Fax:
Practice Address - Street 1:1409 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1920
Practice Address - Country:US
Practice Address - Phone:872-201-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016087101YP2500X
IL180014187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional