Healthcare Provider Details

I. General information

NPI: 1346170271
Provider Name (Legal Business Name): TINA MARIE DOMONKOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA MARIE MASTERS LSW

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SCALP AVE
JOHNSTOWN PA
15904-3036
US

IV. Provider business mailing address

845 DUNKARD HOLLOW RD
ALUM BANK PA
15521-7716
US

V. Phone/Fax

Practice location:
  • Phone: 833-668-6861
  • Fax:
Mailing address:
  • Phone: 833-668-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW133354
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: