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Individual

DR. TANIA LODGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD, PCC-S

Contact information

Practice address
3618 W MARKET ST STE 15, FAIRLAWN, OH 44333-2425
(234) 466-0445
(234) 466-0359
Mailing address
3618 W MARKET ST STE 16, FAIRLAWN, OH 44333-2425
(234) 466-0445

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
E.0500437
OH
103TC0700X
Clinical Psychologist
Primary
P.08616
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0214582
OH
Enumeration date
07/29/2008
Last updated
04/16/2024
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