Provider Demographics
NPI:1245767227
Name:DOMINIQUE, CINDY (LCPC)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:
Last Name:DOMINIQUE
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 1:6072 LAUREL WREATH WAY # 19
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6102
Mailing Address - Country:US
Mailing Address - Phone:443-718-9733
Mailing Address - Fax:
Practice Address - Street 1:6072 LAUREL WREATH WAY # 19
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6102
Practice Address - Country:US
Practice Address - Phone:443-718-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2022101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health