Provider Demographics
NPI:1073049409
Name:HOPKINS, TAKIERRA LANAE
Entity Type:Individual
Prefix:
First Name:TAKIERRA
Middle Name:LANAE
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SOUTH FORK VILLAGE DRIVE
Mailing Address - Street 2:APT 202
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:20812
Mailing Address - Country:US
Mailing Address - Phone:704-719-0832
Mailing Address - Fax:
Practice Address - Street 1:1008 UNION RD
Practice Address - Street 2:STE B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0465
Practice Address - Country:US
Practice Address - Phone:704-719-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist