| Miss Andrea Lynn Dominick, LPCC-S, LICDC | |
|
205 Hospital Dr, Dover, OH 44622-2058 | |
| (330) 343-7950 | |
| Not Available |
| Full Name | Miss Andrea Lynn Dominick |
|---|---|
| Gender | Female |
| Speciality | Counselor - Mental Health |
| Location | 205 Hospital Dr, Dover, Ohio |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235266743 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 111001 (Ohio) | Secondary |
| 101YM0800X | Counselor - Mental Health | E.0600629 SUPV (Ohio) | Primary |
| Entity Name | Coleman Professional Services, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1982637633 PECOS PAC ID: 2769474618 Enrollment ID: O20040331001085 |
| Mailing Address | Practice Location Address |
|---|---|
| Miss Andrea Lynn Dominick, LPCC-S, LICDC 659 Boulevard St, Dover, OH 44622-2026 Ph: (330) 343-3311 | Miss Andrea Lynn Dominick, LPCC-S, LICDC 205 Hospital Dr, Dover, OH 44622-2058 Ph: (330) 343-7950 |
Mrs. Jill Ann Watson, LPC, CTT Counselor Medicare: Not Enrolled in Medicare Practice Location: 547 1/2 S James St, Ste. A, Dover, OH 44622 Phone: 330-343-7400 Fax: 330-343-7414 | |
Jacqueline Lynn Hostetler, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 201 Hospital Dr, Dover, OH 44622 Phone: 330-343-6631 Fax: 330-343-8188 | |
Jessica L Lance, LPCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 130 W 3rd St, Dover, OH 44622 Phone: 330-343-6600 Fax: 330-343-6405 | |
Heather Ely, CDCA Counselor Medicare: Not Enrolled in Medicare Practice Location: 115 S Wooster Ave, Dover, OH 44622 Phone: 513-834-7063 Fax: 513-873-1567 | |
Barbara J Wallis, LPCC-SUPV Counselor Medicare: Not Enrolled in Medicare Practice Location: 130 W 3rd St, Dover, OH 44622 Phone: 330-343-6600 Fax: 330-343-6405 | |
Lindsey Angel Smith, Counselor Medicare: Not Enrolled in Medicare Practice Location: 201 Hospital Dr, Dover, OH 44622 Phone: 330-343-6661 | |
John Gresock, Counselor Medicare: Not Enrolled in Medicare Practice Location: 897 E Iron Ave, Dover, OH 44622 Phone: 330-343-5555 Fax: 330-343-1601 |