Provider Demographics
NPI:1689049645
Name:COLLINS, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 BLACK DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8821
Mailing Address - Country:US
Mailing Address - Phone:678-984-6166
Mailing Address - Fax:
Practice Address - Street 1:809 BLACK DIAMOND DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8821
Practice Address - Country:US
Practice Address - Phone:678-984-6166
Practice Address - Fax:888-209-4480
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor