Provider Demographics
NPI:1093109605
Name:RODYGINA, TATYANA A (MA, LMHC-A)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:A
Last Name:RODYGINA
Suffix:
Gender:F
Credentials:MA, LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 32ND ST NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-2911
Mailing Address - Country:US
Mailing Address - Phone:253-737-8761
Mailing Address - Fax:
Practice Address - Street 1:917 PACIFIC AVE
Practice Address - Street 2:SUITE 416
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4446
Practice Address - Country:US
Practice Address - Phone:253-242-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60500337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health