Provider Demographics
NPI:1700359411
Name:VERNON, TONJA EVONNE (CDPT)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:EVONNE
Last Name:VERNON
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:TONJA
Other - Middle Name:EVONNE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDPT
Mailing Address - Street 1:1723 KRESKY AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-8985
Mailing Address - Country:US
Mailing Address - Phone:360-559-6201
Mailing Address - Fax:360-807-4429
Practice Address - Street 1:1723 KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8985
Practice Address - Country:US
Practice Address - Phone:360-559-6201
Practice Address - Fax:360-807-4429
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60823298101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)