Provider Demographics
NPI:1255625570
Name:DEESE, TONIA JACOBS (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:TONIA
Middle Name:JACOBS
Last Name:DEESE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:TONIA
Other - Middle Name:ROSANA
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3908 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6844
Mailing Address - Country:US
Mailing Address - Phone:919-619-7379
Mailing Address - Fax:
Practice Address - Street 1:3908 ASHTON DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6844
Practice Address - Country:US
Practice Address - Phone:919-619-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0072101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical