Individual
MS. CONNIE RUTH DOMINY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
745 RIVERSIDE DRIVE LN, MACON, GA 31201-2658
(478) 742-8785
(478) 742-3515
Mailing address
745 RIVERSIDE DRIVE LN, MACON, GA 31201-2658
(478) 742-8785
(478) 742-3515
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
002333
GA
Other
Enumeration date
07/03/2007
Last updated
07/08/2007
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