Healthcare Provider Details

I. General information

NPI: 1770496820
Provider Name (Legal Business Name): DOMUS PARADOX PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 CASTLE ROCK SQ APT 11C
RESTON VA
20191-6029
US

IV. Provider business mailing address

2236 CASTLE ROCK SQ APT 11C
RESTON VA
20191-6029
US

V. Phone/Fax

Practice location:
  • Phone: 571-200-7082
  • Fax:
Mailing address:
  • Phone: 571-200-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONYA BERHAN
Title or Position: OWNER
Credential: LPC
Phone: 571-200-7082