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BONNY DOMOTO LPC
NPI 1740173046
Counselor - Mental Health in Marietta, GA

Active since June 03, 2025Opted out of Medicare · through Jun 18, 2027
1640 POWERS FERRY RD SE BLDG 14-200, MARIETTA, GA 30067(888) 551-5168 Get Directions Write a Review

NPPES record last updated: July 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 9, 2025, Jun 3, 2025 (2 updates tracked since 2025).

About Bonny Domoto Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BONNY DOMOTO LPC (NPI 1740173046) is an individual mental health provider in Marietta, Georgia, licensed in Georgia (LPC015728) and active in the NPI registry since June 2025. She has opted out of Medicare through June 18, 2027.

NPPES Registry Identity

NPI1740173046
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameBONNY DOMOTOCredential: LPC
Location Address1640 POWERS FERRY RD SE BLDG 14-200Marietta, GA 30067-1459
Mailing Address1640 Powers Ferry Rd Se Ste 200Marietta, GA 30067-5491 · (888) 551-5168
Phone(888) 551-5168
Sole ProprietorNo
Enumeration DateJune 3, 2025
Last NPPES UpdateJuly 9, 20252 updates tracked since enumeration
NPPES CertifiedJuly 9, 2025
✔ NPI 1740173046 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in GA · LPC015728
1640 POWERS FERRY RD SE BLDG 14-200, Marietta, GA 30067
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Bonny Domoto Lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 18, 2025 through June 18, 2027.

Opt-Out Effective DateJune 18, 2025
Opt-Out In Effect ThroughJune 18, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JASMIN COPELAND MFT
Marriage & Family Therapist
1640 POWERS FERRY RD SE BLDG 14-200
MARIETTA, GA 30067
Cobb County (888) 551-5168
HADIYA TULL
Counselor (Mental Health)
1640 POWERS FERRY RD SE BLDG 14-200
MARIETTA, GA 30067
Cobb County (888) 551-5168
GRACE CADE STEWART MS, NCC
Counselor (Mental Health)
1640 POWERS FERRY RD SE BLDG 14-200
MARIETTA, GA 30067
Cobb County (888) 551-5168
GEORGE OMAR MOUJAES MA
Counselor (Mental Health)
1640 POWERS FERRY RD SE BLDG 14-200
MARIETTA, GA 30067
Cobb County (888) 551-5168
MELISSA LAFONTAINE
Counselor (Mental Health)
1640 POWERS FERRY RD SE BLDG 14-200
MARIETTA, GA 30067
Cobb County (888) 551-5168
TURK ALJALLAL
Social Worker (Clinical)
1640 POWERS FERRY RD SE BLDG 14-200
MARIETTA, GA 30067
Cobb County (888) 551-5168
LIESL ENGELBRECHT NCC
Counselor (Mental Health)
1640 POWERS FERRY RD SE BLDG 14-200
MARIETTA, GA 30067
Cobb County (888) 551-5168
ERICA SHONTA WOMACK LMSW
Social Worker (Clinical)
1640 POWERS FERRY RD SE BLDG 14-200
MARIETTA, GA 30067
Cobb County (770) 342-8072

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bonny Domoto's NPI number?

The NPI number for Bonny Domoto is 1740173046. It was assigned to this individual provider in the NPPES registry on June 3, 2025.

Where is Bonny Domoto located?

Bonny Domoto practices at 1640 Powers Ferry Rd SE Bldg 14-200, Marietta, GA 30067. The listed phone number is (888) 551-5168.

What is Bonny Domoto's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Bonny Domoto enrolled in Medicare?

No. Bonny Domoto has opted out of Medicare through June 18, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Bonny Domoto was last updated on July 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.