Healthcare Provider Details

I. General information

NPI: 1013821560
Provider Name (Legal Business Name): SUNFLOWER THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE
SPOKANE WA
99201-0580
US

IV. Provider business mailing address

156 TOLLGATE TRL
LONGWOOD FL
32750-3855
US

V. Phone/Fax

Practice location:
  • Phone: 407-735-6176
  • Fax: 407-487-8152
Mailing address:
  • Phone: 407-920-5270
  • Fax: 407-487-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA ELIZABETH DOMINGO
Title or Position: CLINICAL THERAPIST, OWNER
Credential: LCSW
Phone: 407-735-6176