Provider Demographics
NPI:1013518802
Name:PRAYLOW, TE'AJA
Entity type:Individual
Prefix:MS
First Name:TE'AJA
Middle Name:
Last Name:PRAYLOW
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 1:11719 PLEASANT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:FL
Mailing Address - Zip Code:32218
Mailing Address - Country:US
Mailing Address - Phone:704-985-3967
Mailing Address - Fax:
Practice Address - Street 1:6816 SOUTHPOINT PKWY STE 500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1702
Practice Address - Country:US
Practice Address - Phone:904-683-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2024-09-26
Deactivation Date:2022-01-24
Deactivation Code:
Reactivation Date:2024-06-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician