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General NPI Number Information
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NPI Number | 1649074113
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Entity Type | Individual
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Provider Name | DOMINIQUE SCOTT MA, RIC, NCC
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Gender | Male
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 1064 LASKIN RD STE 14C
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6337
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Country | US
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Telephone | 757-233-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 705 SEVERN DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6519
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Country | US
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Telephone | 540-478-5076
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704017917
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License Number State | VA
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