Individual
TATIANA MAZIARKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC, LADC
Contact information
Practice address
1858 SAPPHIRE PT, EAGAN, MN 55122-8804
(612) 209-8627
Mailing address
1858 SAPPHIRE PT, EAGAN, MN 55122-8804
(612) 644-0414
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
305115
MN
101YM0800X
Mental Health Counselor
Primary
CC01940
MN
Other
Enumeration date
01/03/2019
Last updated
05/17/2024
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