Provider Demographics
NPI:1134492853
Name:DOMONICA COX
Entity Type:Organization
Organization Name:DOMONICA COX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-299-9060
Mailing Address - Street 1:2555 S DIXIE DR
Mailing Address - Street 2:108
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1539
Mailing Address - Country:US
Mailing Address - Phone:937-299-9060
Mailing Address - Fax:937-299-3040
Practice Address - Street 1:2555 S DIXIE DR
Practice Address - Street 2:108
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-1539
Practice Address - Country:US
Practice Address - Phone:937-299-9060
Practice Address - Fax:937-299-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0602196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty