Provider Demographics
NPI:1871980383
Name:SCHWENKE, TOMINA JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:TOMINA
Middle Name:JEAN
Last Name:SCHWENKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 LIVINGSTON PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3947
Mailing Address - Country:US
Mailing Address - Phone:404-285-0608
Mailing Address - Fax:
Practice Address - Street 1:748 LIVINGSTON PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3947
Practice Address - Country:US
Practice Address - Phone:404-285-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003671103TC0700X
GA3671103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic