Provider Demographics
NPI:1437850526
Name:VEGA, TATIANNA
Entity type:Individual
Prefix:
First Name:TATIANNA
Middle Name:
Last Name:VEGA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CROCKER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2558
Mailing Address - Country:US
Mailing Address - Phone:586-468-2266
Mailing Address - Fax:586-468-4505
Practice Address - Street 1:2 CROCKER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2558
Practice Address - Country:US
Practice Address - Phone:586-458-2266
Practice Address - Fax:586-468-4505
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor