Provider Demographics
NPI:1285307942
Name:WHITE, DOMINECAA (LPC)
Entity type:Individual
Prefix:MRS
First Name:DOMINECAA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:DOMINECAA
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PERRY
Mailing Address - Street 1:45 E MONTEREY WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2757
Mailing Address - Country:US
Mailing Address - Phone:480-489-2866
Mailing Address - Fax:
Practice Address - Street 1:45 E MONTEREY WAY STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2757
Practice Address - Country:US
Practice Address - Phone:480-489-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional