Provider Demographics
NPI:1053899203
Name:ROGINA, CHIAH JASMINE (SUDCC)
Entity type:Individual
Prefix:MRS
First Name:CHIAH
Middle Name:JASMINE
Last Name:ROGINA
Suffix:
Gender:F
Credentials:SUDCC
Other - Prefix:
Other - First Name:CHIAH
Other - Middle Name:JASMINE
Other - Last Name:CASSELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUDCC
Mailing Address - Street 1:810 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3410
Mailing Address - Country:US
Mailing Address - Phone:707-462-7267
Mailing Address - Fax:
Practice Address - Street 1:810 N STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3410
Practice Address - Country:US
Practice Address - Phone:707-462-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8142101YA0400X, 225400000X
CA12790-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)