Provider Demographics
NPI:1235527649
Name:MILLER, TONJIA MARIE (SW)
Entity Type:Individual
Prefix:
First Name:TONJIA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-2610
Mailing Address - Country:US
Mailing Address - Phone:662-902-1503
Mailing Address - Fax:662-624-4462
Practice Address - Street 1:410 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-2610
Practice Address - Country:US
Practice Address - Phone:662-902-1503
Practice Address - Fax:662-624-4462
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst