Provider Demographics
NPI:1558069500
Name:BLAZINA, TONYA RAE (BA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:RAE
Last Name:BLAZINA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:RAE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-2518
Mailing Address - Country:US
Mailing Address - Phone:717-273-8000
Mailing Address - Fax:
Practice Address - Street 1:3030 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-2518
Practice Address - Country:US
Practice Address - Phone:717-306-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)