Provider Demographics
NPI:1285938019
Name:WALKOWIAK, DOMINIQUE MARIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:MARIE
Last Name:WALKOWIAK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:DOMINIQUE
Other - Middle Name:MARIE
Other - Last Name:CELLINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:897 DELAWARE AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2087
Mailing Address - Country:US
Mailing Address - Phone:716-245-4443
Mailing Address - Fax:
Practice Address - Street 1:897 DELAWARE AVE STE 209
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2087
Practice Address - Country:US
Practice Address - Phone:716-245-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY007368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)