Provider Demographics
NPI:1023110798
Name:FRIDY, TONYA L (PHD)
Entity type:Individual
Prefix:DR
First Name:TONYA
Middle Name:L
Last Name:FRIDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47594
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20753-7594
Mailing Address - Country:US
Mailing Address - Phone:703-838-9878
Mailing Address - Fax:703-838-9879
Practice Address - Street 1:300 S WASHINGTON ST
Practice Address - Street 2:STE. 206
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5403
Practice Address - Country:US
Practice Address - Phone:703-838-9878
Practice Address - Fax:703-838-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490346Medicare ID - Type Unspecified