Healthcare Provider Details

I. General information

NPI: 1861062903
Provider Name (Legal Business Name): AMBER RENEE DOMINIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER NIKOLAUS

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 08/11/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 KENHORST BLVD
READING PA
19611-1716
US

IV. Provider business mailing address

45 WESLEYAN DRIVE
READING PA
19607-2211
US

V. Phone/Fax

Practice location:
  • Phone: 610-827-5935
  • Fax:
Mailing address:
  • Phone: 717-669-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC000795
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018997
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: