Individual
BETH A DOMINGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9808 VENICE BLVD STE 700, CULVER CITY, CA 90232-6824
(310) 945-3350
(310) 840-7023
Mailing address
9808 VENICE BLVD STE 700, CULVER CITY, CA 90232-6824
(310) 945-3350
(310) 840-7023
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
32872
CA
1041C0700X
Clinical Social Worker
Primary
85661
CA
225400000X
Rehabilitation Practitioner
—
—
Other
Enumeration date
09/25/2009
Last updated
09/10/2018
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