Provider Demographics
NPI:1174271357
Name:GILLINGS, DOMINIQUE MERCEDES
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MERCEDES
Last Name:GILLINGS
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 1:1107 CUERNO ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-1346
Mailing Address - Country:US
Mailing Address - Phone:850-544-4349
Mailing Address - Fax:
Practice Address - Street 1:3010 HIGHLAND OAKS TER
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3841
Practice Address - Country:US
Practice Address - Phone:850-544-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-77491103K00000X
FLRBT-22-201423106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician