Provider Demographics
NPI:1790144624
Name:CRAYTON, QUALONDA DENISE
Entity Type:Individual
Prefix:MRS
First Name:QUALONDA
Middle Name:DENISE
Last Name:CRAYTON
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 1:1932 REALISTIC DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4654
Mailing Address - Country:US
Mailing Address - Phone:817-881-3936
Mailing Address - Fax:682-738-3173
Practice Address - Street 1:1932 REALISTIC DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4654
Practice Address - Country:US
Practice Address - Phone:817-881-3936
Practice Address - Fax:682-738-3173
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-20
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities