Provider Demographics
NPI:1376180372
Name:HERRING, TYAZIA DREKAARAH
Entity Type:Individual
Prefix:
First Name:TYAZIA
Middle Name:DREKAARAH
Last Name:HERRING
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 1:9641 EAGLE FEATHERS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-8948
Mailing Address - Country:US
Mailing Address - Phone:704-249-1195
Mailing Address - Fax:
Practice Address - Street 1:9641 EAGLE FEATHERS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-8948
Practice Address - Country:US
Practice Address - Phone:704-249-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician