Healthcare Provider Details

I. General information

NPI: 1386074870
Provider Name (Legal Business Name): DOMINIQUE O COLLINS HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WISCONSIN AVE NW SUITE 300
WASHINGTON DC
20007-3603
US

IV. Provider business mailing address

920 DELAFIELD PL NW
WASHINGTON DC
20011-4516
US

V. Phone/Fax

Practice location:
  • Phone: 202-955-8355
  • Fax:
Mailing address:
  • Phone: 202-489-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA6317
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: