Provider Demographics
NPI:1861909020
Name:CHILDERS, TONDA ELLINGTON (MA; LPCA)
Entity type:Individual
Prefix:
First Name:TONDA
Middle Name:ELLINGTON
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MA; LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6705
Mailing Address - Country:US
Mailing Address - Phone:704-956-7719
Mailing Address - Fax:
Practice Address - Street 1:140 CABARRUS AVE W STE 19
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28025-5150
Practice Address - Country:US
Practice Address - Phone:704-956-7719
Practice Address - Fax:704-599-3826
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional