Provider Demographics
NPI:1679012496
Name:LEE, TONJA SIMMONS
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:SIMMONS
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONJA
Other - Middle Name:M
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 SADDLEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3503
Mailing Address - Country:US
Mailing Address - Phone:478-954-9285
Mailing Address - Fax:
Practice Address - Street 1:416 DUNBAR RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1202
Practice Address - Country:US
Practice Address - Phone:478-954-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional