Bonny Domoto, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC015728 Issued in GA

Practice address

1640 Powers Ferry Rd SE BLDG 14-200
Marietta, GA 30067-1459

Phone

(888) 551-5168

NPI assigned

Jun 3, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 18, 2025 through Jun 18, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summit's Edge Counseling & Personal Development

  • Mental Health Counselor
  • Marietta, GA
  • NPI 1942744859
  NPD (past)

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

{
    "created_epoch": "1748908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1740173046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 POWERS FERRY RD SE STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300675491",
            "telephone_number": "888-551-5168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 POWERS FERRY RD SE BLDG 14-200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300671459",
            "telephone_number": "888-551-5168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMOTO",
        "first_name": "BONNY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-03",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC015728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Dodson, CRNA
• Alicia Larae Doles, CRNA
• Barbara S. Dolin, LPC, CT
• Karen Benson Dolph, RPH
• Dominion DME Inc
• Caitlin Dodd Donahue, LPC
• Donald W Alexander, MD PC
• Paul Louis Donaldson Jr., DC
• Yanique S Donaldson, FNP
• Yuliyan Donchev, MD

• Mental Health Counselor in Marietta, GA
• Providers in Marietta, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.