Provider Demographics
NPI:1992268114
Name:DOMINIQUE-MAIKELL, NIKOLE L (LMFT)
Entity type:Individual
Prefix:
First Name:NIKOLE
Middle Name:L
Last Name:DOMINIQUE-MAIKELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 STUMPF BLVD
Mailing Address - Street 2:BUILDING 2 SUITE 5
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-4828
Mailing Address - Country:US
Mailing Address - Phone:504-233-2295
Mailing Address - Fax:
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BUILDING 2 SUITE 5
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-4828
Practice Address - Country:US
Practice Address - Phone:504-233-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health