Domingo, Ebony

Domingo, Ebony is an sole proprietor health care provider with primary practice located at 1582 N Waggoner Rd , Blacklick OH 43004-8669. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Other Service Providers / Case Manager/Care Coordinator. Other Service Providers / Case Manager/Care Coordinator is her primary health care specialty. Domingo, Ebony can be contacted via phone (303) 989-8169.

Contact Information

Primary practice address
1582 N Waggoner Rd Blacklick OH 43004-8669
Phone: (303) 989-8169
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X
Other Service Providers / Case Manager/Care Coordinator 171M00000X

Profile Details

NPI number 1518582394
LBN Legal business name Domingo, Ebony
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 8th, 2020
Last updated Jul 23rd, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518582394 NPPES
Ohio MEDICAID 2910854

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