Healthcare Provider Details

I. General information

NPI: 1053236778
Provider Name (Legal Business Name): RHEANNA NICOLE YAKUDA DOMINICI CRC, LMHCA WA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 MCPHEE RD SW
OLYMPIA WA
98502-5014
US

IV. Provider business mailing address

HAKODAMACHI 594-2 RYUMIERU A 115
MAEBASHI GUNMA
3710837
JP

V. Phone/Fax

Practice location:
  • Phone: 360-799-5782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70088122
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: