Provider Demographics
NPI:1275288045
Name:DOMINY, JULIET B (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:B
Last Name:DOMINY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 WILLOWLAKE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-9517
Mailing Address - Country:US
Mailing Address - Phone:601-527-5486
Mailing Address - Fax:
Practice Address - Street 1:1180 WILLOWLAKE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-9517
Practice Address - Country:US
Practice Address - Phone:601-527-5486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC73231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical