Provider Demographics
NPI:1295244986
Name:EATON, QUANYA NICHOLLE (MSW, LCSW-A)
Entity type:Individual
Prefix:MS
First Name:QUANYA
Middle Name:NICHOLLE
Last Name:EATON
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 KALLAMDALE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9826
Mailing Address - Country:US
Mailing Address - Phone:336-303-2587
Mailing Address - Fax:
Practice Address - Street 1:7 OAK BRANCH DR STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2392
Practice Address - Country:US
Practice Address - Phone:336-856-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0118301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical