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NPI Code Detail

MEDICARE: DOMONIQUE DESHIELDS LPC, LPCMH, LMSW

MEDICARE: DOMONIQUE DESHIELDS LPC, LPCMH, LMSW
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
1101YM0800XMental Health CounselorPC-0011050DE
2101YP2500XProfessional Counselor9542LA
3101YP2500XProfessional Counselor7305TN

General Provider Information

NPI Number : 1932759677
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMONIQUE DESHIELDS LPC, LPCMH, LMSW
Provider Business Mailing Address
First Line : 514 GILROY CT
Second Line :
City : ANTIOCH
State : TN
Zip : 37013-8906
Country : US
Telephone Number : 302-353-2604
Fax Number :
Provider Business Practice Location Address
First Line : 500 28TH AVE N STE 210
Second Line :
City : NASHVILLE
State : TN
Zip : 37209-4456
Country : US
Telephone Number : 615-208-2908
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2019
Last Update Date : 07/18/2025

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