Provider Demographics
NPI:1871050955
Name:CONNELLY, TOWANDA NICOLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TOWANDA
Middle Name:NICOLE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:TOWANDA
Other - Middle Name:NICOLE
Other - Last Name:TILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5412 W APOLLO RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-6951
Mailing Address - Country:US
Mailing Address - Phone:267-236-6820
Mailing Address - Fax:
Practice Address - Street 1:5412 W APOLLO RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-6951
Practice Address - Country:US
Practice Address - Phone:267-236-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-175711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical