Individual
MRS. TONYA CROCKETT OMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPA
Contact information
Practice address
3500 WESTGATE DR, BLDG. 100 STE. 101, DURHAM, NC 27707-2567
(919) 423-3431
(919) 403-6106
Mailing address
3500 WESTGATE DR, BLDG. 100 STE. 101, DURHAM, NC 27707-2567
(919) 423-3431
(919) 403-6106
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2523
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6107031
—
NC
Enumeration date
11/28/2006
Last updated
08/24/2012
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