Healthcare Provider Details

I. General information

NPI: 1336069764
Provider Name (Legal Business Name): DOMINIQUE MONROE BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 JUNIPER RD
LITTLE ROCK AR
72209-4641
US

IV. Provider business mailing address

10801 PAUL EELLS DR
NORTH LITTLE ROCK AR
72113-7608
US

V. Phone/Fax

Practice location:
  • Phone: 501-235-0950
  • Fax:
Mailing address:
  • Phone: 501-234-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: