1326272998 NPI number — JUANITA DARLENE TONEY LPC, Q-SAP

Table of content: JUANITA DARLENE TONEY LPC, Q-SAP (NPI 1326272998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326272998 NPI number — JUANITA DARLENE TONEY LPC, Q-SAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TONEY
Provider First Name:
JUANITA
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, Q-SAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TONEY
Provider Other First Name:
MISSY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, Q-SAP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1326272998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5818 N PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIXSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37343-4619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-874-1993
Provider Business Mailing Address Fax Number:
423-874-1993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 BATTLEFIELD PKWY
Provider Second Line Business Practice Location Address:
STE 1458 2B
Provider Business Practice Location Address City Name:
FT OGLETHORPE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30742-3923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-322-2360
Provider Business Practice Location Address Fax Number:
423-874-1993
Provider Enumeration Date:
05/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC0000002430 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC005301 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160416020A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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