Provider Demographics
NPI:1942040084
Name:NORMAN, DOMINQUE MARIE (DSW, LMSW)
Entity type:Individual
Prefix:
First Name:DOMINQUE
Middle Name:MARIE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:DSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GRAND STAND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-8124
Mailing Address - Country:US
Mailing Address - Phone:716-697-8349
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY # 401
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8941-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker