Provider Demographics
NPI:1164216289
Name:SCHWEINHARDT, DOMINIQUE (LPC, ADDC)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:SCHWEINHARDT
Suffix:
Gender:F
Credentials:LPC, ADDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5625
Mailing Address - Country:US
Mailing Address - Phone:719-425-9160
Mailing Address - Fax:
Practice Address - Street 1:17 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5625
Practice Address - Country:US
Practice Address - Phone:719-425-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0021696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000199663Medicaid