Individual
DOMONIQUE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
4200 MONUMENT RD, PHILADELPHIA, PA 19131-1689
(877) 927-0775
Mailing address
4200 MONUMENT RD, PHILADELPHIA, PA 19131-1689
(877) 927-0775
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PC17769
PA
101YP2500X
Professional Counselor
Primary
PC17769
PA
Other
Enumeration date
11/05/2024
Last updated
05/08/2025
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