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General NPI Number Information
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NPI Number | 1174710248
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Entity Type | Organization
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Legal Business Name | TONYA OMAR, PLLC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 2634 DURHAM CHAPEL HILL BLVD STE 4
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City | DURHAM
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State | NC
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Zip | 27707-2877
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Country | US
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Telephone | 919-402-8738
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Fax | 919-869-2341
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Provider Business Mailing Address
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Address Line | 2634 DURHAM CHAPEL HILL BLVD STE 4
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City | DURHAM
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State | NC
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Zip | 27707-2877
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Country | US
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Telephone | 919-402-8738
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Fax | 919-869-2341
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Authorized Official
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Title or Position | OWNER
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Name | TONYA CROCKETT OMAR
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Credential | MA, LPA
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Telephone | 919-402-8738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2523
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17981
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 17981
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2523
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License Number State | NC
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