Provider Demographics
NPI:1588909683
Name:GRAGG-MCCOY, TONYA RENEE (MSW, LISW-S)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:RENEE
Last Name:GRAGG-MCCOY
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 PATRICIAN DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9685
Mailing Address - Country:US
Mailing Address - Phone:740-466-6527
Mailing Address - Fax:
Practice Address - Street 1:280 PATRICIAN DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9685
Practice Address - Country:US
Practice Address - Phone:740-466-6527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.11008581041C0700X
OHI 14514151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical