Provider Demographics
NPI:1588946149
Name:PREWITT, TONYA J (LISW)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:J
Last Name:PREWITT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:J
Other - Last Name:BLANKENHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24865 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2512
Mailing Address - Country:US
Mailing Address - Phone:248-703-4621
Mailing Address - Fax:
Practice Address - Street 1:24865 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2512
Practice Address - Country:US
Practice Address - Phone:248-703-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11001291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical