Provider Demographics
NPI:1558852335
Name:STEPHENS, TONIA LEE (MSW)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:LEE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 N SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1421
Mailing Address - Country:US
Mailing Address - Phone:714-561-1978
Mailing Address - Fax:
Practice Address - Street 1:4202 N SUNSET ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1421
Practice Address - Country:US
Practice Address - Phone:714-561-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAR1269141217101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty