Provider Demographics
NPI:1689280539
Name:HORNSBY, TARAE BRUNETTE (LICSW, PIP)
Entity Type:Individual
Prefix:
First Name:TARAE
Middle Name:BRUNETTE
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:MS
Other - First Name:TARAE
Other - Middle Name:BRUNETTE
Other - Last Name:HORNSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW, PIP
Mailing Address - Street 1:708 TWIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2855
Mailing Address - Country:US
Mailing Address - Phone:205-213-7157
Mailing Address - Fax:
Practice Address - Street 1:700 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1927
Practice Address - Country:US
Practice Address - Phone:205-933-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1511-2397C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical