Healthcare Provider Details

I. General information

NPI: 1023250578
Provider Name (Legal Business Name): TONYA LYNN HEGWOOD MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 LILAC DR
MORROW GA
30260-1545
US

IV. Provider business mailing address

2614 LILAC DR
MORROW GA
30260-1545
US

V. Phone/Fax

Practice location:
  • Phone: 317-809-3850
  • Fax:
Mailing address:
  • Phone: 317-809-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116835
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8767
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008974
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006260A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: