Provider Demographics
NPI:1013627538
Name:QUAVE, ANNETTA JEAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNETTA
Middle Name:JEAN
Last Name:QUAVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 NAVIDAD ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-2110
Mailing Address - Country:US
Mailing Address - Phone:979-557-9243
Mailing Address - Fax:
Practice Address - Street 1:62 NAVIDAD ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-2110
Practice Address - Country:US
Practice Address - Phone:979-557-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical