Provider Demographics
NPI:1811730047
Name:TAYLOR, DOMINIQUE L (CAREGIVER)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:L
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23098 CUSHING AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1726
Mailing Address - Country:US
Mailing Address - Phone:313-686-8870
Mailing Address - Fax:
Practice Address - Street 1:23098 CUSHING AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1726
Practice Address - Country:US
Practice Address - Phone:313-686-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker