Individual
MARIAH SHARELLE DOMINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S. M.A.
Contact information
Practice address
8211 SUMMA AVE STE F, BATON ROUGE, LA 70809
(225) 761-1970
Mailing address
8211 SUMMA AVE STE F, BATON ROUGE, LA 70809-3471
(225) 761-1970
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC7778
LA
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
01/06/2017
Last updated
03/22/2023
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