Provider Demographics
NPI:1205253499
Name:SHORTER, TONYA RENEE
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:RENEE
Last Name:SHORTER
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 1:1009 HOMESITE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-3529
Mailing Address - Country:US
Mailing Address - Phone:856-655-8012
Mailing Address - Fax:856-225-7650
Practice Address - Street 1:1009 HOMESITE AVE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-3529
Practice Address - Country:US
Practice Address - Phone:856-655-8012
Practice Address - Fax:856-225-7650
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)