Provider Demographics
NPI:1962254318
Name:DAGANG, TIARA CHRISTINA
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:CHRISTINA
Last Name:DAGANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 58TH DR NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-6619
Mailing Address - Country:US
Mailing Address - Phone:360-454-8307
Mailing Address - Fax:
Practice Address - Street 1:10621 58TH DR NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-6619
Practice Address - Country:US
Practice Address - Phone:360-454-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61532044106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst