Healthcare Provider Details

I. General information

NPI: 1083329577
Provider Name (Legal Business Name): DOMINIQUE L WALKER PHD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29445 RANCHO CALIFORNIA RD APT 315
TEMECULA CA
92591-5222
US

IV. Provider business mailing address

29445 RANCHO CALIFORNIA RD APT 315
TEMECULA CA
92591-5222
US

V. Phone/Fax

Practice location:
  • Phone: 562-414-7565
  • Fax:
Mailing address:
  • Phone: 562-414-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: