Healthcare Provider Details

I. General information

NPI: 1750179115
Provider Name (Legal Business Name): DOMINIQUE BELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 WOODLEY RD STE 6
TOLEDO OH
43606-1174
US

IV. Provider business mailing address

4430 N HOLLAND SYLVANIA RD APT 4105
TOLEDO OH
43623-3562
US

V. Phone/Fax

Practice location:
  • Phone: 313-244-7977
  • Fax:
Mailing address:
  • Phone: 313-244-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: