Individual
DOMINIQUE WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 831-5535
(313) 831-2608
Mailing address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 831-5535
(313) 831-2608
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401017213
MI
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
6401017213
MI
247200000X
Other Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891143996
—
MI
Enumeration date
05/31/2016
Last updated
12/03/2020
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