MEDICARE: MACIE DOMINIQUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1124787411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACIE DOMINIQUE

Provider Business Mailing Address
First Line	:	12712 E CASPIAN PL
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1975
Country	:	US
Telephone Number	:	720-263-6244
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 S TROY ST STE 6-200
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1984
Country	:	US
Telephone Number	:	720-263-6244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	05/15/2024

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Directions to “ MACIE DOMINIQUE ” Practice Location

Language	Start Address	Practice Location

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