Provider Demographics
NPI:1548775323
Name:PAYNE, TAMIKA DANYEL (LCDC)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:DANYEL
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304A E CENTRAL TEXAS EXPY STE A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-7308
Mailing Address - Country:US
Mailing Address - Phone:254-638-8680
Mailing Address - Fax:
Practice Address - Street 1:4304A E CENTRAL TEXAS EXPY STE A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7308
Practice Address - Country:US
Practice Address - Phone:254-638-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13213101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)