Provider Demographics
NPI:1205408036
Name:PAYNTER, QIANA JAQUAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:QIANA
Middle Name:JAQUAY
Last Name:PAYNTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8975 INGRAM LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7019
Mailing Address - Country:US
Mailing Address - Phone:317-507-9887
Mailing Address - Fax:
Practice Address - Street 1:8975 INGRAM LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7019
Practice Address - Country:US
Practice Address - Phone:317-507-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007719A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical