Individual
DOMINIQUE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,LCPC, LMHC THLT
Contact information
Practice address
9200 S EMERALD AVE, CHICAGO, IL 60620-2741
(904) 452-6725
Mailing address
9200 S EMERALD AVE, CHICAGO, IL 60620-2741
(044) 526-7259
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
TPMC5372
FL
101YP2500X
Professional Counselor
Primary
180.016118
IL
Other
Enumeration date
09/20/2021
Last updated
10/22/2025
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