Provider Demographics
NPI:1174320600
Name:DOMA LIMITED
Entity type:Organization
Organization Name:DOMA LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WNUKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LPCC
Authorized Official - Phone:614-648-3662
Mailing Address - Street 1:5695 MEDALLION DR E
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9746
Mailing Address - Country:US
Mailing Address - Phone:614-648-3662
Mailing Address - Fax:
Practice Address - Street 1:10 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1601
Practice Address - Country:US
Practice Address - Phone:614-648-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1891009866Medicaid
OH1740943687Medicaid