Active NPI
Victoria Nicole Domenech
- Behavior Technician
- North Charleston, SC
National Provider Identifier
1831876218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-23-281009
- Practice address
- 2810 Ashley Phosphate Rd
North Charleston, SC 29418-6405 - Phone
- (843) 813-1538
- NPI assigned
- Jun 28, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-23-281009 | SC | Primary |
Addresses
Primary practice location
2810 Ashley Phosphate Rd
North Charleston, SC 29418-6405
Mailing address
9345 Blue House Rd Apt No12205
Ladson, SC 29456-4076
Phone (757) 648-0331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-23-281009 | SC | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689724800000",
"number": "1831876218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9345 BLUE HOUSE RD APT NO12205",
"city": "LADSON",
"state": "SC",
"postal_code": "294564076",
"telephone_number": "757-648-0331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2810 ASHLEY PHOSPHATE RD",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294186405",
"telephone_number": "843-813-1538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMENECH",
"first_name": "VICTORIA",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-28",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "SC",
"license": "RBT-23-281009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.