Provider Demographics
NPI:1467701078
Name:POGORZALA, TINA LEIGH (LMHC 12509)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LEIGH
Last Name:POGORZALA
Suffix:
Gender:F
Credentials:LMHC 12509
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4350
Mailing Address - Country:US
Mailing Address - Phone:813-239-8298
Mailing Address - Fax:813-272-3766
Practice Address - Street 1:5707 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4350
Practice Address - Country:US
Practice Address - Phone:813-239-8298
Practice Address - Fax:813-272-3766
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker