Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dominique Phua

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1053784413

Dominique Phua is a Clinical Social Worker in Grand Rapids, Michigan. Qualified in 2014, 12 years ago. Practices as a sole proprietor. Licensed in Michigan.

Years since qualifying
12
Licensed in
MI
In the registry since
2015
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Practice location Address checks out

1115 Ball Ave NE
Grand Rapids, MI 49505-5904
Phone: (616) 459-7215
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence 3743369 (MI)

Record details

NPI number1053784413
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 7, 2015
Last updated in NPPESNovember 7, 2015

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Accepts Medicare assignment Not indicated

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