Provider Demographics
NPI:1861364549
Name:WEBER, DOMINIQUE MESHA (RBT)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MESHA
Last Name:WEBER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 DESLIN CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-6400
Mailing Address - Country:US
Mailing Address - Phone:850-274-5594
Mailing Address - Fax:
Practice Address - Street 1:4514 DESLIN CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-6400
Practice Address - Country:US
Practice Address - Phone:850-274-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-474426106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty