Provider Demographics
NPI:1780030544
Name:WOODS, TONYA MARIE (MS)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:WOODS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:MARIE
Other - Last Name:MARSTELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2220 COUNTY ROAD 210 W STE 108-313
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4058
Mailing Address - Country:US
Mailing Address - Phone:904-446-8428
Mailing Address - Fax:844-770-0422
Practice Address - Street 1:762 SCRUB JAY DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1729
Practice Address - Country:US
Practice Address - Phone:904-446-8428
Practice Address - Fax:844-770-0422
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002795103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-14-17431OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD
PABH002795OtherBEHAVIOR SPECIALIST LICENSE