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General NPI Number Information
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NPI Number | 1871276998
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Entity Type | Organization
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Legal Business Name | DOMINATING THERAPEUTIC SERVICES, PLLC
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 2428 CHARLES BLVD STE 102
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City | GREENVILLE
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State | NC
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Zip | 27858-6052
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Country | US
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Telephone | 919-882-9289
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Fax |
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Provider Business Mailing Address
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Address Line | 418 FARMINGWOOD RD
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City | GREENVILLE
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State | NC
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Zip | 27858-8786
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Country | US
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Telephone | 252-531-6226
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MS. TARA SANDREA ROACH
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Credential | MSW,LCSW,LCAS,CCSOTS
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Telephone | 252-531-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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