Individual
ELLIOT DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
360 S GRANT AVE, COLUMBUS, OH 43215-5537
(614) 398-3470
Mailing address
360 S GRANT AVE, COLUMBUS, OH 43215-5537
(614) 398-3470
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
183562
OH
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/21/2023
Last updated
04/24/2024
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