Healthcare Provider Details

I. General information

NPI: 1275350571
Provider Name (Legal Business Name): DOMINIQUE CREER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SCENIC AVE
BERKELEY CA
94709-1395
US

IV. Provider business mailing address

1820 SCENIC AVE
BERKELEY CA
94709-1395
US

V. Phone/Fax

Practice location:
  • Phone: 866-772-8491
  • Fax:
Mailing address:
  • Phone: 866-772-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: