Provider Demographics
NPI:1891775839
Name:DOMAN, CAROL A (LMSW, BCD, LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:DOMAN
Suffix:
Gender:F
Credentials:LMSW, BCD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10294 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-9702
Mailing Address - Country:US
Mailing Address - Phone:989-781-5606
Mailing Address - Fax:989-781-5663
Practice Address - Street 1:10294 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-9702
Practice Address - Country:US
Practice Address - Phone:989-781-5606
Practice Address - Fax:989-781-5663
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010122771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08906869802Medicare ID - Type Unspecified