Provider Demographics
NPI:1992255665
Name:TONYA OMAR, PLLC DBA THE AYA CENTER
Entity type:Organization
Organization Name:TONYA OMAR, PLLC DBA THE AYA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTIOR
Authorized Official - Prefix:
Authorized Official - First Name:EMISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:919-402-8738
Mailing Address - Street 1:3500 WESTGATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2568
Mailing Address - Country:US
Mailing Address - Phone:919-402-8738
Mailing Address - Fax:
Practice Address - Street 1:3500 WESTGATE DR STE 101
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2568
Practice Address - Country:US
Practice Address - Phone:919-402-8738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0108561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty