Provider Demographics
NPI:1346320447
Name:HARMON, DOMINIQUE CHANEL (LCSW)
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:CHANEL
Last Name:HARMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DOMINIQUE
Other - Middle Name:HARMON
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1708 PEACHTREE ST, NW
Mailing Address - Street 2:SUITE 425
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-7020
Mailing Address - Country:US
Mailing Address - Phone:678-561-6994
Mailing Address - Fax:
Practice Address - Street 1:1708 PEACHTREE ST, NW, SUITE 425
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-7020
Practice Address - Country:US
Practice Address - Phone:678-561-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW003395OtherCLINICAL SOCIAL WORKER