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General NPI Number Information
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NPI Number | 1730767542
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Entity Type | Organization
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Legal Business Name | EIGHT DOMAINS LLC
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1500 FELLOWS PL APT 3C
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City | COLUMBIA
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State | MO
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Zip | 65201-8529
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Country | US
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Telephone | 573-212-4456
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Fax | 573-970-3007
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Provider Business Mailing Address
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Address Line | 115 CONLEY RD # 1032
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City | COLUMBIA
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State | MO
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Zip | 65201-6465
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Country | US
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Telephone | 573-212-4456
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Fax | 573-970-3007
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Authorized Official
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Title or Position | OWNER
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Name | AMBER LIPONOGA
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Credential | LCSWQ
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Telephone | 573-212-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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