Provider Demographics
NPI:1124708474
Name:WARNE, LA-QUISHA ANN
Entity type:Individual
Prefix:
First Name:LA-QUISHA
Middle Name:ANN
Last Name:WARNE
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 1:3317 BRADEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3064
Mailing Address - Country:US
Mailing Address - Phone:980-230-7687
Mailing Address - Fax:
Practice Address - Street 1:3317 BRADEN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3064
Practice Address - Country:US
Practice Address - Phone:980-230-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician