Provider Demographics
NPI:1508225038
Name:WILSON, TONYA WAJCIECHOWSKI (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:WAJCIECHOWSKI
Last Name:WILSON
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 E PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2368
Mailing Address - Country:US
Mailing Address - Phone:434-365-9702
Mailing Address - Fax:
Practice Address - Street 1:4916 PLANK RD UPPR SUITE8
Practice Address - Street 2:
Practice Address - City:NORTH GARDEN
Practice Address - State:VA
Practice Address - Zip Code:22959-1613
Practice Address - Country:US
Practice Address - Phone:434-365-9702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000650103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst