Individual
DOMINIQUE PAGE DUBOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12790 SE STARK ST, PORTLAND, OR 97233-1552
(503) 328-1512
(503) 238-2436
Mailing address
6420 S MACADAM AVE STE 330, PORTLAND, OR 97239-3564
(503) 477-7878
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L6771
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123190
—
OR
Enumeration date
11/12/2010
Last updated
12/09/2024
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