Provider Demographics
NPI:1104218783
Name:EVANS, TONYA (MS, BSW, CADC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, BSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MH
Mailing Address - Zip Code:48506
Mailing Address - Country:US
Mailing Address - Phone:989-754-8598
Mailing Address - Fax:989-754-5154
Practice Address - Street 1:128 N WARREN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48506
Practice Address - Country:US
Practice Address - Phone:989-754-8598
Practice Address - Fax:989-754-5154
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator