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NPI Code Detail

MEDICARE: MIA DOMINGUEZ- HITCHCOCK LCDC, LMSW

MEDICARE: MIA DOMINGUEZ- HITCHCOCK LCDC, LMSW
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1881557213
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIA DOMINGUEZ- HITCHCOCK LCDC, LMSW
Provider Business Mailing Address
First Line : PO BOX 2603
Second Line :
City : FORT WORTH
State : TX
Zip : 76113-2603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3840 HULEN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-7277
Country : US
Telephone Number : 817-335-3022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2025
Last Update Date : 12/03/2025

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Directions to “ MIA DOMINGUEZ- HITCHCOCK LCDC, LMSW” Practice Location

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