Individual
ELIZABETH DOMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
170 BENNETT ST, BRIDGEPORT, CT 06605-2901
(203) 330-6790
Mailing address
170 BENNETT ST, BRIDGEPORT, CT 06605-2901
(203) 330-6790
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2811
CT
Other
Enumeration date
08/26/2015
Last updated
08/26/2015
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