Provider Demographics
NPI:1396094843
Name:CALLOWAY, JQUITA PAYNE (DOCTORATE)
Entity type:Individual
Prefix:PROF
First Name:JQUITA
Middle Name:PAYNE
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N STAR RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-7853
Mailing Address - Country:US
Mailing Address - Phone:214-509-9323
Mailing Address - Fax:
Practice Address - Street 1:12 N STAR RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-7853
Practice Address - Country:US
Practice Address - Phone:214-509-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health