Provider Demographics
NPI:1851008049
Name:FORTUNE, TONIA JO (ABA)
Entity Type:Individual
Prefix:MRS
First Name:TONIA
Middle Name:JO
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 WASHINGTON ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-1333
Mailing Address - Country:US
Mailing Address - Phone:304-202-1699
Mailing Address - Fax:
Practice Address - Street 1:1303 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1333
Practice Address - Country:US
Practice Address - Phone:304-202-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst