Provider Demographics
NPI:1427133628
Name:TONKOVICH, JOELLE ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JOELLE
Middle Name:ANNE
Last Name:TONKOVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 OLD TOWN AVE
Mailing Address - Street 2:SUITE B-100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2930
Mailing Address - Country:US
Mailing Address - Phone:619-405-5916
Mailing Address - Fax:619-299-9089
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:SUITE B-100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2930
Practice Address - Country:US
Practice Address - Phone:619-405-5916
Practice Address - Fax:619-299-9089
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS216851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS21685OtherLICENSE