Healthcare Provider Details

I. General information

NPI: 1164083184
Provider Name (Legal Business Name): TONJA CATRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 04/19/2022
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 W MARKET ST
XENIA OH
45385-2815
US

IV. Provider business mailing address

452 W MARKET ST
XENIA OH
45385-2815
US

V. Phone/Fax

Practice location:
  • Phone: 937-376-8700
  • Fax:
Mailing address:
  • Phone: 937-376-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA174120
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: