Provider Demographics
NPI:1376746370
Name:CLAY, QUANDA U (LLPC)
Entity Type:Individual
Prefix:MS
First Name:QUANDA
Middle Name:U
Last Name:CLAY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3412
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-3412
Mailing Address - Country:US
Mailing Address - Phone:313-212-9711
Mailing Address - Fax:
Practice Address - Street 1:2301 VAN DYKE ST
Practice Address - Street 2:RM. 506
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3958
Practice Address - Country:US
Practice Address - Phone:313-866-9973
Practice Address - Fax:313-866-5749
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007559101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health