Provider Demographics
NPI:1780358770
Name:STRONG, DOMINIQUE (AAS)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OVERLOOK RIDGE DR # AR20099
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1123
Mailing Address - Country:US
Mailing Address - Phone:818-805-8015
Mailing Address - Fax:
Practice Address - Street 1:108 N GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7840
Practice Address - Country:US
Practice Address - Phone:818-805-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171R00000XOther Service ProvidersInterpreter