Individual
DOMINIQUEA EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
806 PHILLIPS LN, STATESVILLE, NC 28625-4596
(602) 525-7997
Mailing address
806 PHILLIPS LN, STATESVILLE, NC 28625-4596
(602) 525-7997
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
18434
AZ
1041C0700X
Clinical Social Worker
Primary
20424
AZ
Other
Enumeration date
04/06/2022
Last updated
08/04/2024
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