Provider Demographics
NPI:1619148442
Name:HUCKS-BRADSHAW, TONYA CAMILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:CAMILLE
Last Name:HUCKS-BRADSHAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TONYA
Other - Middle Name:CAMILLE
Other - Last Name:HUCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 2319
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-2319
Mailing Address - Country:US
Mailing Address - Phone:706-951-7746
Mailing Address - Fax:
Practice Address - Street 1:200 OUTLET POINTE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5667
Practice Address - Country:US
Practice Address - Phone:706-951-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003098103TC0700X
KS1732103TC0700X
SC1138103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical