Individual
MRS. TIFFANY A DOMINEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
500 NEW START RD, BRONSTON, KY 42518-8572
(606) 561-5797
(606) 561-9928
Mailing address
500 NEW START RD, BRONSTON, KY 42518-8572
(606) 561-5797
(606) 561-9928
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1561
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127314
—
KY
Enumeration date
04/01/2013
Last updated
06/06/2016
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