| Domenique Edwards, Pllc | |
|
5602 California Ave Sw Seattle WA 98136-1515 | |
| (206) 538-2255 | |
| (206) 538-2266 |
| Full Name | Domenique Edwards, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 5602 California Ave Sw, Seattle, Washington |
| Authorized Official Name and Position | Domenique Edwards (OWNER/PROVIDER) |
| Authorized Official Contact | 2065382255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Domenique Edwards, Pllc 2611 Sw Nevada St Unit B Seattle WA 98126-2535 Ph: (206) 920-5949 | Domenique Edwards, Pllc 5602 California Ave Sw Seattle WA 98136-1515 Ph: (206) 538-2255 |
| NPI Number | 1821751702 |
|---|---|
| Provider Enumeration Date | 10/18/2021 |
| Last Update Date | 03/22/2023 |
| Certification Date | 03/22/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821751702 | NPI | - | NPPES |
| 1336675529 | Other | TYPE I NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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