Provider Demographics
NPI:1184384596
Name:UPSHAW, TONJA JOHNSON (LPC)
Entity type:Individual
Prefix:MRS
First Name:TONJA
Middle Name:JOHNSON
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2744
Mailing Address - Country:US
Mailing Address - Phone:706-315-5853
Mailing Address - Fax:
Practice Address - Street 1:2815 WARM SPRINGS RD STE 1-B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6857
Practice Address - Country:US
Practice Address - Phone:706-315-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional