Provider Demographics
NPI:1447855432
Name:SAMUELS, TONYA DENISE (LMFT)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:DENISE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 BRANDEN WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6285
Mailing Address - Country:US
Mailing Address - Phone:912-549-0309
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGHWAY 27 STE 4
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2411
Practice Address - Country:US
Practice Address - Phone:352-708-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist