Individual
MRS. DOMINIQUE AMESCUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, CI
Contact information
Practice address
8402 CROSS PARK DR, AUSTIN, TX 78754-4595
(512) 697-8665
Mailing address
8402 CROSS PARK DR, AUSTIN, TX 78754-4595
(512) 697-8665
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17559
TX
1041C0700X
Clinical Social Worker
Primary
56594
TX
Other
Enumeration date
12/04/2012
Last updated
12/04/2012
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