Provider Demographics
NPI:1598876781
Name:CORREALE, TANIA MICHELLE DAVIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:MICHELLE DAVIS
Last Name:CORREALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:MAILSTOP S116ATC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-277-3932
Mailing Address - Fax:206-764-2293
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:MAILSTOP S116ATC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-3932
Practice Address - Fax:206-764-2293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPY2284103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)