Provider Demographics
NPI:1346712387
Name:HORNE, DEYZJANAE NICOLE (ASW)
Entity Type:Individual
Prefix:
First Name:DEYZJANAE
Middle Name:NICOLE
Last Name:HORNE
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASW
Mailing Address - Street 1:827 W AVENUE L APT 48
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7138
Mailing Address - Country:US
Mailing Address - Phone:661-330-9644
Mailing Address - Fax:
Practice Address - Street 1:1600 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2814
Practice Address - Country:US
Practice Address - Phone:661-949-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW85382104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker