Individual
BRE A. DOMESCIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
260 S 1ST ST STE 2, ZIONSVILLE, IN 46077-1602
(317) 827-7719
Mailing address
260 S 1ST ST STE 2, ZIONSVILLE, IN 46077-1602
(317) 827-7719
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39003707A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39003707A
BEHAVIORAL HEALTH BOARD
IN
Enumeration date
06/02/2020
Last updated
06/02/2020
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