Provider Demographics
NPI:1467036707
Name:CARADINE, TAKIYA LANIECE
Entity Type:Individual
Prefix:
First Name:TAKIYA
Middle Name:LANIECE
Last Name:CARADINE
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 1:8323 SOUTHWEST FWY STE 425
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1618
Mailing Address - Country:US
Mailing Address - Phone:832-831-6178
Mailing Address - Fax:
Practice Address - Street 1:8323 SOUTHWEST FWY STE 425
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1618
Practice Address - Country:US
Practice Address - Phone:832-831-6178
Practice Address - Fax:832-550-2814
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health