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General NPI Number Information
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NPI Number | 1669170734
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Entity Type | Individual
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Provider Name | DOMINIQUE PASHA LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1 HERITAGE PLACE SUITE 520
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City | SOUTHGATE
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State | MI
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Zip | 48195
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Country | US
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Telephone | 313-909-0696
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Fax |
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Provider Business Mailing Address
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Address Line | 245 CAMPBELL ST
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City | RIVER ROUGE
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State | MI
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Zip | 48218-1008
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Country | US
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Telephone | 313-909-0696
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851115725
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801119476
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License Number State | MI
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