Healthcare Provider Details

I. General information

NPI: 1942040084
Provider Name (Legal Business Name): DOMINQUE MARIE NORMAN DSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 401
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

29 GRAND STAND DR
AUSTIN AR
72007-8124
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-6547
  • Fax:
Mailing address:
  • Phone: 716-697-8349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8941-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: