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General NPI Number Information
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NPI Number | 1043372873
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Entity Type | Individual
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Provider Name | TOMI THOMPSON DOMINGUEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 9600 VETERAN'S DRIVE SW BLDG 61 ROOM 136 PUGET SOUND VA- AMERICAN LAKE DIVISION
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City | TACOMA
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State | WA
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Zip | 98493
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Country | US
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Telephone | 253-583-2741
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Fax | 253-589-4183
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Provider Business Mailing Address
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Address Line | 9600 VETERAN'S DRIVE SW BLDG 61 ROOM 136 PUGET SOUND VA- AMERICAN LAKE DIVISION
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City | TACOMA
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State | WA
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Zip | 98493
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Country | US
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Telephone | 253-583-2741
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Fax | 253-589-4183
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | TXSW11082
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License Number State | TX
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