Provider Demographics
NPI:1174797831
Name:MCCORMICK, TONI ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:ELAINE
Last Name:MCCORMICK
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 1:12870 HAWKEYE LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-8140
Mailing Address - Country:US
Mailing Address - Phone:775-721-1751
Mailing Address - Fax:530-823-7017
Practice Address - Street 1:164 MAPLE ST STE 5
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5049
Practice Address - Country:US
Practice Address - Phone:775-721-1751
Practice Address - Fax:530-823-7701
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker