Healthcare Provider Details

I. General information

NPI: 1376104323
Provider Name (Legal Business Name): DOMINIQUIE CLEMMONS-JAMES PHD, LPC, CRC, BCB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 VANSTORY ST
GREENSBORO NC
27407-4731
US

IV. Provider business mailing address

2615 VANSTORY ST
GREENSBORO NC
27407-4731
US

V. Phone/Fax

Practice location:
  • Phone: 803-673-2846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: