Provider Demographics
NPI:1134938889
Name:WILLIAMS, DOMINIQUE RENEE
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 CAT ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-6607
Mailing Address - Country:US
Mailing Address - Phone:985-607-4889
Mailing Address - Fax:
Practice Address - Street 1:4500 SHERWOOD COMMON BLVD APT 506
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4258
Practice Address - Country:US
Practice Address - Phone:985-607-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker