MEDICARE: DOMINIQUE WASHINGTON LMFTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist		WA

General Provider Information

NPI Number	:	1528543261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE WASHINGTON LMFTA

Provider Business Mailing Address
First Line	:	4030 LAKE WASHINGTON BLVD NE STE 201
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7870
Country	:	US
Telephone Number	:	206-414-8918
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 LAKE WASHINGTON BLVD NE STE 201
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7870
Country	:	US
Telephone Number	:	206-414-8918
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	05/24/2023

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