MEDICARE: DR. CINDY DOMINIQUE LCPC

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	101YM0800X	Mental Health Counselor	LC2022	MD
2	101YP2500X	Professional Counselor	LC2022	MD

General Provider Information

NPI Number	:	1245767227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CINDY DOMINIQUE LCPC

Provider Business Mailing Address
First Line	:	6072 LAUREL WREATH WAY # 19
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-6102
Country	:	US
Telephone Number	:	443-718-9733
Fax Number	:

Provider Business Practice Location Address
First Line	:	6072 LAUREL WREATH WAY # 19
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-6102
Country	:	US
Telephone Number	:	443-718-9733
Fax Number	:

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

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	01/14/2025

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