Provider Demographics
NPI:1508661075
Name:NEAVE, TARA BRIANNE (BT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:BRIANNE
Last Name:NEAVE
Suffix:
Gender:
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HAYDEN LANE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326
Mailing Address - Country:US
Mailing Address - Phone:813-305-5928
Mailing Address - Fax:
Practice Address - Street 1:901 W TRADE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1143
Practice Address - Country:US
Practice Address - Phone:718-736-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician