Provider Demographics
NPI:1376663120
Name:HERNING, CAROLYNN ANNE
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:ANNE
Last Name:HERNING
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 1:15447 ANACAPA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2481
Mailing Address - Country:US
Mailing Address - Phone:760-245-9446
Mailing Address - Fax:760-951-8986
Practice Address - Street 1:15447 ANACAPA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2481
Practice Address - Country:US
Practice Address - Phone:760-245-9446
Practice Address - Fax:760-951-8986
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)