Provider Demographics
NPI:1760718613
Name:RUSHIN, TAJUANA DENISE (MA, MRT, CART, CLST)
Entity Type:Individual
Prefix:
First Name:TAJUANA
Middle Name:DENISE
Last Name:RUSHIN
Suffix:
Gender:F
Credentials:MA, MRT, CART, CLST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608896
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32860-8896
Mailing Address - Country:US
Mailing Address - Phone:407-929-9019
Mailing Address - Fax:321-396-7574
Practice Address - Street 1:6141 METROWEST BLVD UNIT 306
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2970
Practice Address - Country:US
Practice Address - Phone:407-929-9019
Practice Address - Fax:321-396-7574
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor