Provider Demographics
NPI:1487231064
Name:CROFTON, DEQUANDA LASHAWN
Entity Type:Individual
Prefix:
First Name:DEQUANDA
Middle Name:LASHAWN
Last Name:CROFTON
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 1:211 N SHIAWASSEE ST STE A
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-1444
Mailing Address - Country:US
Mailing Address - Phone:989-494-0404
Mailing Address - Fax:
Practice Address - Street 1:211 N SHIAWASSEE ST STE A
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1444
Practice Address - Country:US
Practice Address - Phone:989-494-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 106S00000X, 171M00000X
MI6451023155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator