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General NPI Number Information
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NPI Number | 1689639809
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Entity Type | Individual
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Provider Name | STEVEN BERNARD DOMIENIK MA, LPCC
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 205 W 4TH ST
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City | CINCINNATI
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State | OH
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Zip | 45202-4812
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Country | US
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Telephone | 513-582-6834
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Fax |
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Provider Business Mailing Address
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Address Line | 6803 BANTRY AVE
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City | CINCINNATI
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State | OH
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Zip | 45213-1133
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Country | US
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Telephone | 513-631-2289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E0003848
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License Number State | OH
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