Provider Demographics
NPI:1649730219
Name:ARLINE, RICKETTA TIARA (M, ED)
Entity type:Individual
Prefix:
First Name:RICKETTA
Middle Name:TIARA
Last Name:ARLINE
Suffix:
Gender:F
Credentials:M, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S MARION AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-7034
Mailing Address - Country:US
Mailing Address - Phone:800-817-5404
Mailing Address - Fax:
Practice Address - Street 1:260 S MARION AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7034
Practice Address - Country:US
Practice Address - Phone:800-817-5404
Practice Address - Fax:904-775-3570
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health