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Individual

BRIAN LEE DOMITROVICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SUDCC II

Contact information

Practice address
280 17TH ST, OAKLAND, CA 94612-4124
(510) 238-5020
Mailing address
6649 FOOTHILL BLVD UNIT 2, OAKLAND, CA 94605-2018
(415) 318-0375

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13534
CA
171M00000X
Case Manager/Care Coordinator
Primary
13534
CA
373H00000X
Day Training/Habilitation Specialist
Primary
13534
CA

Other

Enumeration date
07/22/2020
Last updated
04/07/2026
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