Individual
MS. TINATIN SURGULADZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DH.D.
Contact information
Practice address
205 WATERMAN ST SUITE 106, PROVIDENCE, RI 02906
(857) 333-0533
Mailing address
3 BURGESS RD, FOSTER, RI 02825
(857) 333-0533
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
11259
MA
103T00000X
Psychologist
Primary
PS01795
RI
Other
Enumeration date
09/26/2014
Last updated
04/29/2020
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