MEDICARE: MS. QUANDA U CLAY LLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401007559	MI
2	171M00000X	Case Manager/Care Coordinator	6401007559	MI

General Provider Information

NPI Number	:	1376746370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. QUANDA U CLAY LLPC

Provider Business Mailing Address
First Line	:	PO BOX 3412
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48037-3412
Country	:	US
Telephone Number	:	313-212-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 VAN DYKE ST
Second Line	:	RM. 506
City	:	DETROIT
State	:	MI
Zip	:	48214-3958
Country	:	US
Telephone Number	:	313-866-9973
Fax Number	:	313-866-5749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/29/2019

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