Provider Demographics
NPI:1215069448
Name:DOMINIC, PEMI (LPC)
Entity type:Individual
Prefix:
First Name:PEMI
Middle Name:
Last Name:DOMINIC
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-0365
Mailing Address - Country:US
Mailing Address - Phone:704-948-6649
Mailing Address - Fax:704-948-6960
Practice Address - Street 1:10210 HICKORYWOOD HILL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3332
Practice Address - Country:US
Practice Address - Phone:704-948-6649
Practice Address - Fax:704-948-6960
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3297101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor