Provider Demographics
NPI:1407601099
Name:HOUSTON-BURDEN, CQUANICA (LCSWA)
Entity Type:Individual
Prefix:
First Name:CQUANICA
Middle Name:
Last Name:HOUSTON-BURDEN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S GARNETT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4511
Mailing Address - Country:US
Mailing Address - Phone:919-606-9136
Mailing Address - Fax:
Practice Address - Street 1:704 S GARNETT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4511
Practice Address - Country:US
Practice Address - Phone:919-606-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0198281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty