Provider Demographics
NPI:1336916907
Name:ROSE, TOMOKO TAGUCHI (MA)
Entity Type:Individual
Prefix:MS
First Name:TOMOKO
Middle Name:TAGUCHI
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 ROGER BACON DR STE 15
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5202
Mailing Address - Country:US
Mailing Address - Phone:571-455-5206
Mailing Address - Fax:703-636-8983
Practice Address - Street 1:11250 ROGER BACON DR STE 15
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5202
Practice Address - Country:US
Practice Address - Phone:571-455-5206
Practice Address - Fax:703-636-8983
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health