Healthcare Provider Details

I. General information

NPI: 1598036600
Provider Name (Legal Business Name): DOMINIQUE DRIESSEN ESPANA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 MEMORIAL DRIVE SUITE E-10
SAVANNAH GA
31406
US

IV. Provider business mailing address

7370 MEMORIAL DRIVE SUITE E-10
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 843-422-5290
  • Fax:
Mailing address:
  • Phone: 843-422-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012095A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2010-R
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006663
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: