Provider Demographics
NPI:1811708407
Name:CADDELL, TONNEKA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:TONNEKA
Middle Name:M
Last Name:CADDELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9668 MILLIKEN AVE STE 104-207
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6137
Mailing Address - Country:US
Mailing Address - Phone:909-605-3114
Mailing Address - Fax:
Practice Address - Street 1:9668 MILLIKEN AVE STE 104-207
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6137
Practice Address - Country:US
Practice Address - Phone:909-605-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0200X
CAPSY32848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic