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

Individual provider Social Worker · NPI 1619618212

Dominiquea Edmiston, LCSW is a Social Worker in Statesville, North Carolina. Works from 2 locations. Licensed in Arizona.

Licensed in
AZ
In the registry since
2022
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

806 Phillips Ln
Statesville, NC 28625-4596
Phone: (602) 525-7997
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1115 E Lemon St, Tempe, AZ 85281-4028 — (602) 525-7997

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 20424 (AZ)
Social Worker Taxonomy 104100000X · Licence 18434 (AZ)

Record details

NPI number1619618212
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedApril 6, 2022
Last updated in NPPESAugust 4, 2024
Certification dateJuly 20, 2022

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