Provider Demographics
NPI:1922894203
Name:FREEMAN, DOMINIQUE MARIE (LMHC)
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:MARIE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ORION WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-4416
Mailing Address - Country:US
Mailing Address - Phone:407-520-6353
Mailing Address - Fax:
Practice Address - Street 1:1300 RED JOHN DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-1075
Practice Address - Country:US
Practice Address - Phone:386-254-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health