Healthcare Provider Details

I. General information

NPI: 1811523558
Provider Name (Legal Business Name): DOMINIQUE RENE ATER MS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS DOMINIQUE RENE BICKEL

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FAYETTE CTR
WASHINGTON COURT HOUSE OH
43160-2120
US

IV. Provider business mailing address

344 WALNUT ST
CIRCLEVILLE OH
43113-2226
US

V. Phone/Fax

Practice location:
  • Phone: 740-335-8228
  • Fax:
Mailing address:
  • Phone: 740-412-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPP-000333305
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2103239
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: