Provider Information for 1174125322
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
DOMINIQUE LATRECE SQUIRE LCSW
Sex: Female
NPI: 1174125322
Last Updated: 2024-05-22
Certification Date: 2024-05-22
Certification Date: 2024-05-22
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1174125322 | ||||||||
| Enumeration Date | 2020-11-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 575 S SQUARE DR APT 103 WINTERVILLE, NC 28590-8699 United States Phone: 919-423-7483 | Fax: | ||||||||
| Primary Practice Address | 575 S SQUARE DR APT 103 WINTERVILLE, NC 28590-8699 United States Phone: 919-423-7483 | Fax: | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|