Provider Demographics
NPI:1386391068
Name:HENDERSON, TONYA M (C2203873-TRNE)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:C2203873-TRNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 N HOLLAND SYLVANIA RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4159 N HOLLAND SYLVANIA RD STE 205
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4801
Practice Address - Country:US
Practice Address - Phone:419-318-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health