Provider Demographics
NPI:1972198943
Name:RODIA, TIARA NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:NICOLE
Last Name:RODIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ABBEY TER APT 305W
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2030
Mailing Address - Country:US
Mailing Address - Phone:610-888-5827
Mailing Address - Fax:
Practice Address - Street 1:600 ABBOTT DR
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4317
Practice Address - Country:US
Practice Address - Phone:484-476-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional