Provider Demographics
NPI:1750006805
Name:FAIR, RAQUIA (CNA1/2 MT,)
Entity type:Individual
Prefix:MISS
First Name:RAQUIA
Middle Name:
Last Name:FAIR
Suffix:
Gender:F
Credentials:CNA1/2 MT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 EMMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6024
Mailing Address - Country:US
Mailing Address - Phone:336-594-9298
Mailing Address - Fax:
Practice Address - Street 1:3694 EMMA AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6024
Practice Address - Country:US
Practice Address - Phone:336-594-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker