Provider Demographics
NPI:1396353553
Name:DOMENECH, THOMASIN (MS, ALC)
Entity type:Individual
Prefix:
First Name:THOMASIN
Middle Name:
Last Name:DOMENECH
Suffix:
Gender:F
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 LIME QUARRY RD STE 111
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8975
Mailing Address - Country:US
Mailing Address - Phone:256-278-2802
Mailing Address - Fax:
Practice Address - Street 1:810 SHONEY DR SW STE 115
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5450
Practice Address - Country:US
Practice Address - Phone:256-527-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC03911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health