Provider Demographics
NPI:1104072750
Name:QIAN, NAN
Entity type:Individual
Prefix:MRS
First Name:NAN
Middle Name:
Last Name:QIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-1524
Mailing Address - Country:US
Mailing Address - Phone:803-796-6179
Mailing Address - Fax:
Practice Address - Street 1:2105 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-1524
Practice Address - Country:US
Practice Address - Phone:803-796-6179
Practice Address - Fax:803-796-0353
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health