Provider Demographics
NPI:1326865502
Name:GRISSETT-GASKINS, TONYANEKA C
Entity type:Individual
Prefix:
First Name:TONYANEKA
Middle Name:C
Last Name:GRISSETT-GASKINS
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 1:103 RESEDA LN
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-7320
Mailing Address - Country:US
Mailing Address - Phone:251-229-1072
Mailing Address - Fax:
Practice Address - Street 1:2543 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4925
Practice Address - Country:US
Practice Address - Phone:334-699-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-24-363565106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician