Provider Demographics
NPI:1134753650
Name:WINGATE, TONYA LATRECE
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LATRECE
Last Name:WINGATE
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:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29540-0622
Mailing Address - Country:US
Mailing Address - Phone:843-992-6824
Mailing Address - Fax:843-306-8786
Practice Address - Street 1:817 N SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29540-7914
Practice Address - Country:US
Practice Address - Phone:843-992-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency