Healthcare Provider Details

I. General information

NPI: 1780460014
Provider Name (Legal Business Name): DOMINIQUE DUBOIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 DIXON AVE
LAFAYETTE CO
80026-8879
US

IV. Provider business mailing address

1455 DIXON AVE
LAFAYETTE CO
80026-8879
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-8500
  • Fax:
Mailing address:
  • Phone: 303-443-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002706
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.099933276
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: