Provider Demographics
NPI:1669170734
Name:PASHA, DOMINIQUE (LLMSW)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:PASHA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 CAMPBELL ST.
Mailing Address - Street 2:
Mailing Address - City:RIVER ROUGE
Mailing Address - State:MI
Mailing Address - Zip Code:48218
Mailing Address - Country:US
Mailing Address - Phone:313-909-0696
Mailing Address - Fax:
Practice Address - Street 1:1 HERITAGE PLACE SUITE 520
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195
Practice Address - Country:US
Practice Address - Phone:313-909-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511157251041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical