Provider Demographics
NPI:1831856749
Name:DOMINGUEZ, REBECCA ALEXIS (LMHC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ALEXIS
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15211 FINTRY PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1424
Mailing Address - Country:US
Mailing Address - Phone:786-718-5650
Mailing Address - Fax:
Practice Address - Street 1:15211 FINTRY PL
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1424
Practice Address - Country:US
Practice Address - Phone:786-718-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty