Provider Demographics
NPI:1376092957
Name:DOUGLAS, TONYA JOY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:JOY
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:GLEN ST MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-0896
Mailing Address - Country:US
Mailing Address - Phone:904-408-8883
Mailing Address - Fax:904-259-1282
Practice Address - Street 1:19 W MACCLENNY AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2043
Practice Address - Country:US
Practice Address - Phone:904-408-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health