Individual
MS. BRENDA L DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4502 STARKEY RD, SUITE 208, ROANOKE, VA 24018-8539
(540) 772-1263
(540) 772-1264
Mailing address
4502 STARKEY RD, SUITE 208, ROANOKE, VA 24018-8539
(540) 772-1263
(540) 772-1264
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003123
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010125766
—
VA
01
—
163443
ANTHEM
—
01
—
2095633
CIGNA
—
Enumeration date
08/31/2006
Last updated
05/16/2024
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