Healthcare Provider Details

I. General information

NPI: 1033685524
Provider Name (Legal Business Name): TONI-MARIE HYNEMAN LPC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI-MARIE BRYAN LPC, MA

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N MICHIGAN AVE STE 1430
CHICAGO IL
60601-7653
US

IV. Provider business mailing address

12 THAYER AVE SE
ATLANTA GA
30315-2726
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-6780
  • Fax: 224-204-9089
Mailing address:
  • Phone: 404-447-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC013262
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: