Provider Demographics
NPI:1295399905
Name:UNDERWOOD, TONYA (MA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 PINELLAS POINT DR S APT 13
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-6000
Mailing Address - Country:US
Mailing Address - Phone:773-469-1336
Mailing Address - Fax:
Practice Address - Street 1:8800 49TH ST N STE 106
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5332
Practice Address - Country:US
Practice Address - Phone:727-544-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)