Provider Demographics
NPI:1740039080
Name:ASIEDU, TANIKA MADDRIC
Entity type:Individual
Prefix:
First Name:TANIKA
Middle Name:MADDRIC
Last Name:ASIEDU
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 1:374 MORGAN FIELD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-3465
Mailing Address - Country:US
Mailing Address - Phone:443-460-8768
Mailing Address - Fax:
Practice Address - Street 1:374 MORGAN FIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-3465
Practice Address - Country:US
Practice Address - Phone:443-460-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst