Provider Demographics
NPI:1962067629
Name:HEARNS-ANTOINE, TANEEKA (BEHAVIOR HEALTH TECH)
Entity type:Individual
Prefix:
First Name:TANEEKA
Middle Name:
Last Name:HEARNS-ANTOINE
Suffix:
Gender:F
Credentials:BEHAVIOR HEALTH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13484 CORA PL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13484 CORA PL
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3820
Practice Address - Country:US
Practice Address - Phone:951-807-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services