NPIMap

Organization Active NPI

Domina Umbrae LLC

  • Community/Behavioral Health Agency
  • Atlanta, GA
National Provider Identifier
1053748947
Registry record updated Oct 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
LPC004441 Issued in GA
Legal business name
DOMINA UMBRAE LLC
Practice address
2155 Meador Ave SE
Atlanta, GA 30315-7407
Phone
(706) 442-9127
NPI assigned
Oct 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William David Miller, LPCNPI 1831282326
Title
Owner
Phone
(706) 442-9127

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X LPC004441 GA Primary

Addresses

Primary practice location

2155 Meador Ave SE
Atlanta, GA 30315-7407

Mailing address

330 High Hardin Way
Lawrenceville, GA 30043-6091
Phone (706) 442-9127

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381276800000",
    "number": "1053748947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 HIGH HARDIN WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436091",
            "telephone_number": "706-442-9127",
            "fax_number": "732-753-7415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 MEADOR AVE SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303157407",
            "telephone_number": "706-442-9127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINA UMBRAE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-09",
        "last_updated": "2013-10-09",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-442-9127",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC004441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.