Provider Demographics
NPI:1821427014
Name:THEARD, TALIKA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:TALIKA
Middle Name:NICOLE
Last Name:THEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TALIKA
Other - Middle Name:NICOLE
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4530 NW 67TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4034
Mailing Address - Country:US
Mailing Address - Phone:917-342-2793
Mailing Address - Fax:
Practice Address - Street 1:4530 NW 67TH TER
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4034
Practice Address - Country:US
Practice Address - Phone:917-342-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1250685174400000X
VA0133001957103K00000X
GA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist