Individual
GEOFFREY DOMINCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
32100 TELEGRAPH RD STE 205, BINGHAM FARMS, MI 48025-2454
(248) 712-4266
Mailing address
32100 TELEGRAPH RD STE 205, BINGHAM FARMS, MI 48025-2454
(248) 712-4266
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
7401001279
MI
103K00000X
Behavior Analyst
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
12/19/2016
Last updated
11/19/2024
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