Provider Demographics
NPI:1700407053
Name:HERMAN, TASHA NICHOLE
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:NICHOLE
Last Name:HERMAN
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 1:5717 ALAN D GOOD LN
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-7902
Mailing Address - Country:US
Mailing Address - Phone:828-468-1852
Mailing Address - Fax:
Practice Address - Street 1:5717 ALAN D GOOD LN
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-7902
Practice Address - Country:US
Practice Address - Phone:828-468-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician